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•'Wherever  there  is  love  of  mankind,  there 

is  love  of  the  medical  art." 

— Hippocrates. 


PREFACE 


This  book  is  inspired  by  the  belief  that  the  most 
important  knowledge  for  the  individual  is  that  which 
promotes  his  physical  efficiency  and  happiness.  The 
knowledge  that  has  the  power  to  contribute  the  most 
to  these  ends  is  that  which  helps  him  to  preserve  him- 
self in  the  best  state  of  health.  Good  health  is  the 
most  important  prerequisite  for  physical  efficiency 
and  happiness.  Vicious  heredity,  ignorance,  or  lack 
of  conformity-  to  the  known  rules  of  hygiene,  senile 
decay,  and  acquired  diseases  are  conditions  which 
militate  against  good  health.  All  of  these  are  sus- 
ceptible of  amelioration  through  medical  knowledge 
and  education. 

This  is  the  age  of  scientific  methods.  All  of  the 
knowledge  which  is  important  for  man  is  in  process 
of  development  by  some  branch  of  learning.  The 
knowledge  concerning  human  life  belongs  in  the  do- 
main of  the  medical  sciences,  a  department  of  the  bio- 
logic sciences.  The  study  of  the  physical  properties 
of  man  is  called  medical  for  the  reason  that  human 
interest  in  this  study  began  in  what  was  really  a  pre- 
scientific  period,  when  curing  the  ills  of  man  was  the 

ix 


PEEFACE 

first  physical  study  applied  to  him.  Seeking  for 
means  to  alleviate  his  diseases,  in  the  crude  ages  long 
passed,  was  the  very  natural  beginning  of  this  branch 
of  biologic  interest.  Had  mankind  gone  about  this 
study  in  a  truly  scientific  manner,  anatomy,  physi- 
ology, pathology,  and  hygiene  would  have  been  stud- 
ied first,  and  then  the  treatment  of  diseases  built  upon 
these.  But  in  the  beginning  of  enlightened  interest 
in  human  health  scientific  methods  had  not  been 
adopted.  An  objection  to  the  name,  medical,  is  that 
it  confuses  those  who  are  not  familiar  with  scientific 
nomenclature.  The  meaning  and  mission  of  medical 
science  is  often  misunderstood. 

]\Iedicine  is  the  science  devoted  to  the  study  of  the 
hiology  of  man :  and  since  health  is  his  best  posses- 
sion, medical  science  has  as  its  special  aim  the  inves- 
tigation of  those  conditions  which  destroy  his  health, 
and  the  study  of  their  causes,  their  prevention,  and 
their  treatment :  and  ultimately  has  for  its  end  to  pro- 
mote his  physical  efficiency,  to  relieve  pain,  and  to 
prolong  life.     All  of  the^e  are  being  attained. 

It  is  evident  to  the  scientific  mind  that  in  medicine 
there  can  be  no  schools  with  fixed  creeds,  sects,  sys- 
tems, or  short  cuts  to  knowledge.  There  is  but  one 
medical  science,  and  that  is  the  science  which  seeks 
for  the  truth.  Like  all  of  the  sciences,  its  progress 
must  seem  to  the  impatient  to  be  slow,  stumbling, 
and  groping.  But  three  thousand  years  of  research 
and  experience  and  two  hundred  and  fifty  years  of 

X 


PEEFACE 

scientific  methods  have  brought  it  to  a  high  degree 
of  perfection. 

This  branch  of  learning  concerns  deeply  individ- 
uals and  the  public;  but  there  is  still  much  need  of 
an  awakening  of  the  people  and  of  the  state  to  its 
sociologic  significance.  Society  comes  so  closely  in 
contact  with  the  individual  doctor  on  his  mission  of 
healing  and  relieving  distresses  both  of  a  major  and 
minor  nature,  that,  regarding  his  work,  beneficent  as 
it  is,  as  the  typical  activity  of  medical  science,  it  has 
failed  to  look  beyond  and  grasp  the  importance  of 
medical  knowledge  and  the  medical  profession  as  a 
whole,  of  which  the  individual  practitioner  is  but  an 
isolated,  often  imperfect,  human  expression.  More- 
over, the  medical  profession  has  failed  to  place  suffi- 
cient confidence  in  the  public,  and  has  kept  itself 
aloof,  and  denied  the  people  important  knowledge 
which  could  be  of  service  to  them.  This  medical 
aloofness  has  been  prompted  by  the  fear  that  a  little 
knowledge  might  do  more  harm  than  good,  and  by 
the  ethical  desire  not  to  be  misunderstood  or  charged 
with  self-exploitation. 

It  is  hoped  that  this  book  may  help  to  break  down 
this  barrier  between  the  physician  and  the  public, 
and  interest  the  latter  in  the  work  of  the  former, 
and  the  former  in  the  needs  of  the  latter.  The  plea 
that  goes  out  to  the  public  from  the  great  heart  of 
the  medical  profession  to-day  is  that  prevention  shall 
take    the    place    of    cure.      Medical    knowledge    has 

xi 


PREFACE 

reached  that  point  when  much  of  it  can  be  taken  by 
the  public  and,  without  medical  aid,  applied  to  the 
end  of  preventing  diseases.  Again  and  again,  medi- 
cine appeals  to  the  people  to  take  the  measures  nec- 
essary to  stop  trv'phoid,  tuberculosis,  yellow  fever, 
plague,  cholera,  gonorrhea,  syphilis,  and  the  many 
other  destructive  diseases  which  are  clearly  preventa- 
ble. The  earnestness  and  practicability  of  this  ap- 
peal constitute  the  most  important  side  of  medical 
sociology. 

This  book  is  made  up  of  observations  touching  upon 
these  sociologic  relations  of  medicine.  They  are  not 
of  sufficient  fullness  to  be  dignified  by  the  name  of 
essays.  All  of  them  were  written  in  the  seclusion  of 
the  country,  which  must  serve  as  the  excuse  for  the 
meagerness  of  references.  Some  of  them  have  already 
been  published  in  the  New  York  State  Journal  of 
Medicine  at  the  time  the  author  was  editor  of  that 
journal ;  others  are  taken  from  his  addresses,  given 
before  both  medical  and  nonmedical  audiences ;  and 
many  are  here  published  for  the  first  time.  There  is 
for  this  reason  little  attempt  at  sequence  or  continuity 
of  arrangement.  Each  chapter  must  be  regarded  as 
isolated. 

The  book  has  been  divided  into  two  parts :  Part  I 
including  those  chapters  dealing  with  questions  of 
greater  interest  to  the  lay  reader,  and  Part  II  dealing 
"^*ith  questions  having  special  interest  for  the  medical 
reader. 

xii 


PEEFACE 

It  is  hoped  that  these  observations  may  help  lay- 
men, students  of  sociology,  teachers  and  parents  to  a 
better  understanding  of  the  meaning  of  medicine  and 
its  power  to  save;  and  that  for  the  medical  reader 
they  may  furnish  some  entertainment  and  instruc- 
tion, strengthen  his  love  for  his  profession,  and 
awaken  a  fuller  appreciation  of  its  possibilities. 
Some  of  the  chapters  are  little  excursions  across  the 
borderlands  of  medicine,  whither  we  journey  aU  too 
little. 

The  words  of  Descartes,  "  If  it  be  at  all  possible  to 
ennoble  mankind,  it  will  be  through  medicine,"  can 
be  understood  to-day  better  than  ever  before;  and  it 
is  the  belief  of  the  author  that  this  twentieth  century 
is  to  be  characterized  by  a  renewal  of  interest  in 
health  and  physical  efficiency  such  as  the  world  has 
never  known,  because  there  is  to  be  inspired  in  the 
individual  greater  concern  for  his  own  health  and 
a  philanthropic  interest  in  the  health  of  his  brother 
men. 

J.  P.  W. 
386  Washington  Avenue, 

Bbooklyn,  New  York, 


CONTENTS 


PART  I 

THE   SOCIOLOGY    OF   HEALTH 

CHAPTER  PAGE 

I. — Public  Policy  and  the  Medical  Profession  3 
II. — Federal   Interest   in   the    Health    of   the 

People       7 

III. — A  Plea  for  the  Well 23 

IV. — Some    Medical    Aspects    of    Civilization     .  34 

V. — Healthfulness  and  Happiness         ...  42 

VT. — Exercise  and  Health 46 

VII. — The  Alcohol  Question 55 

VIII. — The  Venereal  Peril 70 

IX. — The  Instruction  of  the  Young  in  Sexual 

Hygiene 86 

X. — Sexual  Morality  and  the  State     .        .        .  100 

XI. — Sexual  Continence 112 

XII. — Idle  Wives,  Unmated  Men,  and  the  Venereal 

Peril 118 

XIII.— The  Social  Evil 124 

XIV. — Education  and  the  Health  and  Efficiency 

OF  Girls 128 

XV. — Physical  Fitness  at  the  Throttle         .       .  134 

XVI. — The  Accidents  of  Summer         ....  138 

XVII. — Life  Insurance  Interests          ....  144 
XV 


CONTENTS 

CHAPTER  PAGE 

XVIII. — Unhygienic  Immunity 147 

XIX.— Fresh  Air 150 

XX. — Christian  Science         .       .       .       .       .       .  169 

XXI. — The    Emmanuel    Movement    and     Kindred 

Phenomena 181 

XXII. — Osteopathy 190 

XXIII. — Facts  and  Theories 194 

XXIV.— The  Family  Hazard 197 

XXV. — Eating  and  Talking ,  199 

PART  II 

medical  science  and  medical  art 

I. — The  Evolution  of  Scientific  Knowledge  .  205 

II. — Bacteriology  and  Botany         ....  211 

III. — Spontaneous  Generation 216 

IV. — The    Beginnings   and   Progress    of   Thera- 
peutics   221 

V. — The  Rationalization  of  Therapeutics  .        .  229 

VI. — The  Fate  of  Medicine 240 

VII. — ^The  Future  Fields  op  Medical  Activity      .  245 

VIII. — Medical  Science  and  Human  Progress         .  251 

IX. — Preventive  Medicine 255 

X. — The  Diffusion  op  Medical  Knowledge        .  259 
XI. — College    Preparation    for    the    Study    of 

Medicine 268 

XII. — The  Hospital  Interneship         ....  276 
XIII. — State  and  College  Medical  Examinations  .  281 
XIV, — ^The  State  License  to  Practice  Medicine  .  286 
XV. — The    Practice    op    Medicine    Legally    De- 
fined    290 

XVI. — The  Medical  Expert  Witness  ....  292 

xvi 


CONTENTS 


CHAPTER 

PAGE 

XVII.- 

—The  Preceptor 

297 

XVIIL- 

—The  General  Practitioner  and  the  Clini 

- 

CAL  Assistant 

299 

XIX.- 

—Work  and  Play 

303 

XX.- 

—A  Well-ordered  Life       .        .        .        . 

309 

XXI.- 

—The  Physician  in  Politics 

315 

XXII.- 

—Knowledge  versus  Manners 

320 

XXIII.- 

—Medical  Libraries 

325 

XXIV.- 

—The  History  of  Medicine 

330 

XXV.- 

—The  Small  Medical  Society 

333 

XXVI.- 

—Doctors'  Sons 

335 

XXVII.- 

—Tuberculosis  Preventable     . 

337 

XXVIII.- 

—Medieval  History 

338 

XXIX.- 

— Societies 

339 

XXX.- 

—Jubilee  Membership          .... 

340 

XXXI.- 

—Medical  Practice  in  Utopia  . 

341 

XXXII.- 

—The  Present  Day 

342 

XXXIII.- 

—The  Borderland  of  Truth     . 

343 

XXXIV.- 

—The  Physician's  Calling 

344 

XXXV.- 

—The  Future  of  Medicine 

345 

Index  . 

349 

PART   I 

THE    SOCIOLOGY    OF    HEALTH 


MEDICAL    SOCIOLOGY 


PUBLIC  POLICY  AND  THE   MEDICAL  PEOFESSIOX 

THERE  is  one  important  fact  whicli  the 
public  should  understand,  and  that  is 
that  there  is  no  great  work  in  process 
of  development  which  means  more  to  the  peo- 
ple than  the  advancement  of  the  medical  sci- 
ences. If  society  were  wise  it  would  render 
every  aid  to  medical  progress.  A  reflection 
upon  the  ability  of  the  people  to  take  care  of 
themselves  is  the  fact  that  most  of  the  sanitary 
measures  which  have  been  adopted  for  their 
protection  have  been  fought  for  by  the  medical 
profession  against  strong  opposition.  Medical 
men  have  labored  to  compel  the  adoption  of 
laws  for  the  prevention  of  diseases,  without 
which  laws  our  country  would  be  riddled  with 
pestilence. 

Frequently,  in  this  fight  which  medical  sci- 
3 


MEDICAL    SOCIOLOGY 

ence  is  making  for  the  people  it  loses,  and  some 
danger  to  public  health  is  permitted  to  enter  so- 
ciety. Bnt  ultimately,  by  the  slow  process  of 
education,  it  is  often  made  manifest  to  the  pub- 
lic that  a  revision  of  its  action  is  necessary, 
and  it  adopts  the  policy  which  medicine  ad- 
vised. This  is  done  sometimes  after  the  lesson 
has  cost  a  great  price.  It  is  not  appreciated 
sufficiently  that  there  is  a  profession  the  func- 
tion of  which,  as  a  whole,  is  for  the  public  con- 
servation. Individually,  physicians  often  may 
be  inspired  by  that  beneficent  self-interest  which 
exists  in  all  men;  but  as  an  organized  class, 
what  is  recommended  by  the  medical  profession 
for  the  public  good  has  the  merit  of  true  philan- 
thropy which  no  other  profession  or  avocation 
approaches.  Medicine  is  not  striving  for  the 
acceptance  of  any  particular  scheme,  theory,  or 
doctrine  of  social  betterment ;  it  is  not  laboring 
to  fasten  upon  the  people  any  particular  super- 
stition ;  its  aim  is  to  learn  all  that  can  be  learned 
about  the  laws  of  health,  and  apply  them  to  the 
end  that  pain  may  be  lessened,  sickness  pre- 
vented, physical  efficiency  promoted,  and  death 
postponed.  There  are  a  few  pessimistic  philos- 
ophers, of  the  schools  of  Schopenhauer  and 
Hartmann,  who  do  not  agree  that  all  of  these 

4 


THE    SOCIOLOGY    OF    HEALTH 

are  desirable  things,  but  the  majority  of  peo- 
ple desire  them  all. 

Were  society  wise  it  would  give  the  men  who 
are  striving  for  these  things  every  help.  Un- 
wisely it  does  not.  Here  it  makes  laws  to  the 
prejudice  of  jDublic  health;  there  it  hinders  the 
adoption  of  policies  for  the  saving  of  lives.  In 
Vienna  recently  the  mayor  of  the  city  made  the 
public  statement,  in  the  presence  of  a  smallpox 
epidemic,  that  more  persons  had  died  from  the 
vaccinations  than  from  the  smallpox.  Scien- 
tific men  collected  data,  and  showed  the  mayor 
that  there  was  not  a  case  of  death  or  serious 
injury  following  the  vaccinations,  and  that 
there  had  been  deaths  from  smallpox;  but  the 
mayor  declined  to  retract  his  words.  The  harm 
which  the  public  often  does  itself  through  its 
chosen  representatives  is  very  great.  If  we 
go  a  little  farther  east,  in  India,  we  find  62,000,- 
000  natives  dead  from  star^^ation  and  plague, 
while  the  English  Government  sends  the  grain 
out  of  the  country  to  pay  for  maintaining 
an  enormous  military  and  political  show  (emp- 
tying the  wealth  of  the  Ganges  into  the  Thames) 
and  fails  to  heed  the  plea  of  her  humane  medi- 
cal profession,  which  would  save  suffering  mil- 
lions in  this  afflicted  land.    While  the  work  of 

5 


MEDICAL   SOCIOLOGY 

the  English  medical  men  in  India  is  most  suc- 
cessful, still  their  protest  always  goes  up  that 
it  is  only  palliative,  and  that  they  cannot  secure 
governmental  sanction  or  help  for  preventive 
work.  Japan  gave  heed  to  medical  counsel  and 
saved  her  people. 

If  we  return  to  our  own  country  we  find  that 
in  every  municipality  where  typhoid  fever  ex- 
ists, the  medical  profession  has  advised  the 
people  what  to  do  to  check  the  disease ;  usually 
it  has  pleaded  with  them.  Has  it  advised  the 
people  wrongly?  No.  Has  it  been  unduly  san- 
guine that  mortality  could  be  reduced?  No. 
Has  the  public  ever  accepted  its  recommenda- 
tions without  a  vast  deal  of  parley  and  delay 
while  the  people  kept  on  dying?  No.  And  is  it 
not  a  spectacle  to  be  viewed  with  pity  and 
shame,  that  in  every  large  community  there  are 
people  dying  who  would  be  well  and  happy 
were  the  recommendations  which  the  medical 
profession  has  placed  in  the  hands  of  the  peo- 
ple acted  upon? 


II 

FEDEEAL  INTEREST  IN  THE  HEALTH  OF  THE  PEOPLE 

"To  be  a  good  animal  is  the  first  requisite  to  success  in  life, 
and  to  be  a  nation  of  good  animals  is  the  first  condition  to 
national  prosperity." — Herbert  Spencer. 

"  The  public  health  is  the  foundation  on  which  reposes  the 
happiness  of  the  people  and  the  power  of  a  country.  The  care 
of  the  public  health  is  the  first  duty  of  a  statesman." — Lord 
Beaconsfield. 

THE  Cabinet  of  the  President  of  the 
United  States  is  made  up  of  the  Secre- 
taries of  State,  of  the  Treasury,  of  War, 
of  the  Navy,  of  the  Interior,  of  Commerce  and 
Labor,  and  of  Agriculture,  an  Attorney  Gen- 
eral and  a  Postmaster  General.  These  gentle- 
men are  at  the  heads  of  departments  which 
have  to  do  with  the  economics  of  government; 
but  only  remotely  do  any  of  them  have  to  do 
with  the  very  thing  which  concerns  most  closely 
the  happiness,  and  therefore  the  prosperity,  of 
the  80,000,000  of  people  whom  they  repre- 
sent— their  health.  The  health  of  our  pigs  has 
representation  in  the  Cabinet,  but  not  our  chil- 

7 


MEDICAL    SOCIOLOGY 

dren.  I  shall  not  attempt  to  say  what  the  title 
of  the  officer  should  be  who  jDresides  over  the 
department  the  business  of  which  shall  be  to 
conserve  the  most  vital  interest  of  the  people, 
but  I  shall  say  that  such  a  department  could  be 
made  the  most  useful  and  important  of  all  the 
departments  in  the  Grovernment,  and  I  except 
none.  If  there  were  a  national  department  of 
health,  or  sanitation,  with  a  secretary  at  its 
head,  it  could  serve  the  nation  to  a  degree  of 
efficiency  even  greater  than  that  with  which  our 
municipal  departments  of  health  serve  our  cit- 
ies or, the  State  departments  of  health  serve  our 
States.  That  there  should  be  such  a  depart- 
ment is  one  of  the  most  urgent  needs  of  our 
country.  The  centralization  of  authority  is  es- 
sential for  a  great  work. 

At  the  present  time  there  are  private  soci- 
eties all  over  the  land  endeavoring  as  best  they 
can  to  check  the  ravages  of  tuberculosis.  Sup- 
pose the  powers  of  the  Government  were  turned 
in  this  direction:  it  is  difficult  to  imagine  the 
good  that  would  result.  Municipalities  are 
struggling,  each  in  its  separate  way,  with  the 
typhoid-fever  problem.  If  only  the  Govern- 
ment would  come  to  the  aid  of  all  of  them  with 
a  systematized  campaign  against  typhoid  fever, 

8 


THE    SOCIOLOGY    OF    HEALTH 

can  one  imagine  the  fullness  of  the  beneficent 
results  that  would  accrue! 

If  the  solution  of  the  problem  lay  in  educa- 
tion, think  of  the  facilities  of  the  Government 
for  advancing  the  cause  of  education  and  pub- 
lic information.  The  presses  at  Washington 
are  busy  turning  out  the  effusions  of  Congress- 
men, and  our  mails  distribute  them  broadcast 
over  the  land.  Suppose  these  forces  were  em- 
ployed in  the  campaign  against  tuberculosis  in- 
stead of  in  the  interest,  say,  of  private  corpora- 
tions, might  not  the  public  money  be  spent  to  a 
better  advantage? 

There  are  now  living  in  this  country  8,000,000 
people  who  are  destined  to  die  of  tuberculosis : 
that  is  equivalent  to  all  of  the  people  in  the  State 
of  New  York.  One  hundred  and  seventy-five 
thousand  people  died  last  year  in  the  United 
States  from  that  cause.  Tuberculosis  is  a  pre- 
ventable disease.  The  knowledge  sufficient  for 
its  extermination  is  now  in  the  literature  of 
medicine.  The  State  could  take  this  knowledge 
without  further  medical  assistance  and  con- 
summate the  work.  The  fight  against  tubercu- 
losis should  now  be  in  the  hands  of  the  State. 
Medicine  has  gone  about  as  far  as  it  can.  But 
in  this  fight  the  burden  is  still  made  to  rest  upon 

9 


MEDICAL    SOCIOLOGY 

the  medical  profession.  The  State  is  not  put- 
ting its  hand  to  the  task.  The  man  who  has 
read  history  correctly  knows  that  ultimately  tu- 
berculosis will  be  exterminated.  How  dearly 
we  should  prize  the  saving  of  some  of  those  who 
are  to  be  sacrificed  upon  the  altar  of  delay. 
Suppose  the  Government  should  do  its  best  to 
preserve  some  of  these  8,000,000  people.  Let 
us  say  that  it  saved  only  1,000,000  and  de- 
ferred for  five  years  the  period  of  incapacity 
of  another  million.  The  commercial  value  of 
that  alone  would  pay  all  of  the  expenses  of  a 
national  health  department  conducted  upon  a 
most  elaborate  plan. 

During  the  coming  year  some  1,800,000  peo- 
ple are  destined  to  die  in  the  United  States. 
The  Government  is  spending  money  on  the 
study  of  infusoria  dredged  from  the  bottom  of 
the  sea;  it  is  doing  all  that  it  can  for  the  pro- 
tection of  the  trees  and  pigs ;  and  it  is  devoting 
large  sums  of  money  to  study  and  protect  from 
diseases  clams,  lobsters,  and  shad — all  of  which 
is  most  commendable;  but  while  the  interests 
of  these  things  are  represented  in  the  Cabinet 
of  the  President,  our  people  may  sicken  and 
die  of  diseases  which  governmental  authority 
might  prevent,  while  the  Government,  whose 

10 


THE    SOCIOLOGY   OF   HEALTH 

function  it  is  to  protect  us,  takes  little  cogni- 
zance of  our  plight.  We  need  protection  from 
disease  more  than  from  invading  armies;  and 
our  infant  children  need  protection  more  than 
our  infant  industries.  What  shall  civilized 
peoples  say  of  the  government  which  concerns 
itself  more  with  tuberculosis  in  cows  than  in 
men  f  In  the  United  States  of  America  a  sheep 
with  anthrax  receives  the  attentions  of  a  secre- 
tary of  the  Cabinet ;  but  a  whole  community  of 
men  might  have  this  disease,  and  there  is  no 
secretary  to  interest  himself  for  them  nor  to 
preserve  the  well.  There  are  scores  of  scien- 
tific men  in  this  country  of  infinite  capabilities, 
perhaps  some  who  might  do  for  us  as  much  as 
Pasteur  did  for  France.  We  could  have  their 
services  at  the  rate  of  pay  of  a  colonel  of  in- 
fantry. Does  anyone  believe  that  it  would  not 
be  a  good  investment  for  the  Government  to 
encourage  the  study  of  human  health  and  dis- 
eases? 

According  to  our  last  statistics  we  may  calcu- 
late that  during  the  present  year  about  one  for- 
tieth of  our  population  will  be  constantly  sick, 
which  means  that  continuously  2,000,000  fam- 
ilies, representing  10,000,000  persons,  will  be 
affected  by  sickness.    What  affairs  of  state  are 

11 


MEDICAL    SOCIOLOGY 

more  important  to  this  one  eighth  of  the  popu- 
lation of  the  country"?  What  are  the  many  de- 
partments of  the  Government  doing  to  reduce 
this  morbidity? 

The  thing  which  is  closest  to  the  happiness 
and  prosperity  of  the  people  has  but  meager 
consideration.  The  nearest  we  come  to  it  is  in 
the  Public  Health  and  Marine  Hospital  Service, 
a  small  medical  department  under  the  control 
of  the  Secretary  of  the  Treasury — as  though 
what  is  done  for  the  public  health  must  be  as- 
sociated with  the  dollar  sign!  Common  sense 
and  common  humanity  have  prompted  the  De- 
partment of  Agriculture  to  undertake  much 
work  of  a  distinctly  medical  character.  The 
need  and  opportimities  for  such  work  are  evi- 
dent to  all  observing  people.  Curiously  enough, 
the  Department  of  Agriculture,  according  to 
the  provisions  of  the  Pure  Food  Bill,  is  called 
upon  to  pass  judgment  upon  drugs,  medicines, 
and  foods  intended  only  for  human  use. 

Modern  medicine,  modern  sanitation,  has 
shown  what  it  can  do  to  reduce  mortality  and 
improve  the  health  of  communities.  In  its  benefi- 
cent power  the  Government  would  have  its  most 
potent  agent  to  promote  and  conserve  the  pros- 
perity of  the  people.    Most  of  the  diseases  with 

12 


THE    SOCIOLOGY    OF   HEALTH 

which  these  80,000,000  people  suffer  are  subject 
to  amelioration,  and  many  of  them  are  abso- 
lutely preventable.  Yellow  fever,  tuberculosis, 
typhoid  fever,  malaria,  and  many  other  diseases 
are  susceptible  to  the  interpretations  of  inter- 
state laws  just  as  well  as  the  railroads  are.  One 
State  might  reach  a  high  degree  of  efficiency  in 
dealing  with  them,  but  failure  to  do  so  on  the 
part  of  neighboring  States  would  negative  its 
work.  In  one  State  it  is  forbidden  to  empty 
sewage  into  streams  from  which  towns  below 
take  their  water  supply,  but  in  the  neighboring 
State  sewage  is  emptied  into  these  very  same 
streams.  Lake  Champlain  is  protected  from 
contamination  on  the  New  York  side,  but  Ver- 
mont empties  refuse  into  it.  The  question  of 
the  disposal  of  the  sewage  of  the  cities  is  be- 
coming a  serious  problem.  At  present  it  is 
wasted.  The  cities  are  eating  up  the  nitrogen 
of  the  country  and  dumping  it  into  the  sea. 
This  will  soon  be  recognized  as  a  waste  worthy 
of  national  attention.  Streams  flow,  people 
travel,  insects  fly,  and  winds  blow,  carrying  dis- 
ease from  one  State  into  another;  and  these 
matters  are  too  big  and  too  vital  for  each  com- 
munity to  try  to  settle  for  itself.  Eailroad  cars 
are  not  the  only  things  that  may  carry  trouble 

13 


MEDICAL    SOCIOLO*GY 

between  the  States.  The  milk  consumed  in  New 
York  City  comes  from  at  least  six  different 
States,  all  with  different  laws  and  different  sys- 
tems of  inspection.  The  milk  problem  will 
never  be  solved  satisfactorily  until  there  is  fed- 
eral interest  in  the  country's  milk  supply. 

Each  State  might  have  a  laboratory  for  can- 
cer research,  as  New  York  State  has,  but  a  fed- 
eral laboratory  with  the  power  of  the  Govern- 
ment behind  it  would  have  a  greater  efficiency. 
The  several  States  have  no  relationship  or 
channels  of  official  connection  with  the  coun- 
tries which  are  carrying  on  scientific  work,  but 
the  Federal  Government  has.  The  government 
which  lends  aid  to  foster  the  industries  can  af- 
ford surely  to  aid  the  advancement  of  medical 
science,  the  science  preservative  of  its  brawn 
and  brain. 

The  people  of  this  great  country  are  going  to 
have  a  national  department  of  health.  It  may 
be  deferred,  but  it  is  ine\atable.  The  supervi- 
sion of  the  foods  produced  and  purveyed  to  the 
people,  the  healthfulness  of  trades  and  occupa- 
tions, the  cleanliness  of  the  great  waterways, 
child  labor,  the  safeguarding  of  the  young,  the 
physical  fitness  of  immigrants,  the  instruction 
of  the  people  in  the  care  of  health,  and  the  keep- 

14 


THE    SOCIOLOGY    OF   HEALTH 

ing  of  vital  statistics,  are  but  a  few  of  the  gov- 
ernmental duties  which  are  now  neglected  for 
want  of  a  national  department  of  health.  Such 
a  department  should  frame  laws  for  regulating 
the  practice  of  medicine,  and  recommend  them 
for  adoption  to  the  different  States. 

The  equalization  of  medical  laws  is  much 
needed.  The  requirements  for  practice  should 
be  the  same  in  every  State.  It  should  not  be 
possible  for  a  person  who  is  debarred  from 
practicing  in  one  State  to  find  that  he  can  step 
over  the  line  and  practice  in  another. 

This  country  is  the  most  prodigal  of  all  the 
great  nations  in  its  wastefulness  of  human  lives 
by  accident  as  well  as  by  disease.  As  an  ex- 
ample of  what  is  going  on  in  the  direction  of 
the  unnecessary  destruction  of  lives  a  recent 
report  of  Mr.  Holmes,  chief  of  the  Technical 
Branch  of  the  Department  of  the  Interior,  may 
be  cited.  He  reports  23,000  lives  lost  in  the 
United  States  through  mine  explosions  during 
a  period  of  less  than  eighteen  years.  These 
disasters,  he  says,  are  due  to  lack  of  proper 
regulations,  ignorance,  and  carelessness.  Last 
year  2,000  lives  were  needlessly  sacrificed  in 
our  mines,  and  10,000  lives  were  lost  on  our 
railroads.  The  total  mortality  from  accidents 
3  15 


MEDICAL   SOCIOLOGY 

to  wage-earners  in  the  United  States  is  35,000 
annually;  tlie  non-fatal  accidents  amount  to 
about  200,0000. 

It  is  a  far  cry  from  the  Department  of  the 
Interior  to  the  saving  of  human  lives  or  public 
health.  There  is  a  great  profession  and  a  sci- 
ence devoted  to  the  saving  of  human  lives. 
Study  of  this  subject  has  been  in  progress  by 
this  profession  since  the  dawn  of  civilization, 
but  the  Department  of  the  Interior  has  little  or 
no  relation  to  it.  When  we  have  a  national  de- 
partment whose  specific  function  is  the  preser- 
vation of  life  we  shall  be  approaching  the  sensi- 
ble solution  of  this  question,  and  not  until  then. 

"We  are  deficient  in  national  vital  statistics. 
Without  accurately  compiled  statistics  many 
sanitary  calculations  become  guesswork.  The 
value  of  such  statistics  is  of  especial  impor- 
tance in  determining  the  effects  of  diseases  and 
other  conditions  upon  the  whole  population. 
They  furnish  a  judgment  upon  large  numbers 
of  people,  while  the  best  that  knowledge  other- 
wise could  produce  would  be  upon  a  few  indi- 
viduals. They  also  supply  the  measure  of  the 
vital  phenomena  of  a  population,  the  relation  of 
birth  rate  to  death  rate,  the  prevalent  diseases, 
their  increase  or  diminution,  their  relation  to 

16 


THE    SOCIOLOGY    OF    HEALTH 

climates  and  industrial  conditions,  and  many 
other  invaluable  helps  in  safeguarding  the  well- 
being  of  the  people.  Long  before  hygiene  and 
sanitary  science  had  attained  to  any  consider- 
able degree  of  perfection  the  value  of  such  sta- 
tistics was  recognized.  The  several  States  of 
the  Union  are  each  devoting  a  certain  amount 
of  attention  to  this  matter,  but  with  indifferent 
cooperation  with  one  another.  Some  of  the 
States  have  applied  admirable  systems  in  this 
work,  and  others  have  done  nothing.  Other 
civilized  countries  have  vital  statistics.  "  In 
the  United  States  the  vital  statistics  are  almost 
worthless,"  was  said  in  a  recent  discussion  be- 
fore the  Eoyal  Statistical  Society  of  England, 
and  our  statisticians  know  this  to  be  true.  A 
national  department  of  health  could  remove  this 
reproach. 

European  vital  statistics  show  that  in  the 
middle  of  the  sixteenth  century  the  average 
length  of  human  life  was  twenty  years.  It  has 
increased,  especially  during  the  last  fifty  years, 
until  it  is  now  forty  years.  In  Sweden,  where 
modem  scientific  methods  are  applied  most 
fully,  it  has  risen  to  fifty-two  years,  and  others 
of  the  more  highly  civilized  European  countries 
will  soon  reach  that  figure.    It  is  surely  of  much 

17 


MEDICAL   SOCIOLOGY 

importance  to  a  new-born  babe  whether  his 
period  of  expectancy  shall  be  twenty  years  or 
fifty-two.  The  frightful  death  rate  from  pre- 
ventable diseases  in  the  United  States  makes  it 
absolutely  feasible  to  add  twelve  years  to  the 
average  length  of  life  in  this  country  by  means 
of  the  simple  measures  which  are  already  well 
known  and  proved.  It  is  not  too  much  to  claim 
that  in  a  hundred  years  human  longevity  could 
be  raised  to  sixty  years  if  the  Government 
would  make  conserving  the  health  of  the  peo- 
ple one  of  its  functions. 

Some  day  typhoid  fever  will  be  as  obsolete 
in  civilized  communities  as  cholera  or  smallpox. 
We  possess  all  of  the  information  that  is  nec- 
essary to  make  it  so  now.  It  is  no  longer  a' 
great  and  elusive  mystery.  The  average  third- 
year  medical  student  knows  enough  about  ty- 
phoid fever  to  be  able  to  stamp  it  out  if  he 
were  endowed  with  absolute  power.  Of  course, 
he  would  have  to  interfere  with  the  profits  of  a 
number  of  our  leading  citizens.  This  is  one 
reason  why  typhoid  is  prevalent.  At  pres- 
ent it  is  a  matter  of  barter  for  human  lives.  It 
costs  money  to  convince  an  influential  citizen 
that  the  excrement  of  his  tenants  should  not 
flow  into  a  municipal  water  supply ;  and  it  is  on 

18 


THE    SOCIOLOGY    OF   HEALl'H 

the  border  of  the  impossibilities  to  convince  a 
corporation — for  corporations,  milike  individ- 
uals, it  is  understood  have  no  souls. 

If  a  municipality  should  grant  to  its  health 
commissioner  all  of  the  authority  necessary  to 
this  end,  he  could  cut  down  the  typhoid  death 
rate  to  a  minimum,  but  beyond  a  certain  point 
he  could  not  go  without  the  aid  of  the  State. 
He  could  provide  water  from  the  best  source, 
and  eliminate  most  of  the  avenues  of  contam- 
ination ;  and  he  could  prohibit  the  admission  of 
infected  foods  within  his  jurisdiction.  But  if 
a  railroad  corporation  wished  to  build  a  road 
in  another  State  across  one  of  his  water-supply 
tributary  streams  his  municipal  authority 
would  cut  but  a  poor  figure  in  attempting  to 
stop  it. 

All  over  the  country  railroads  cross  the 
streams  from  which  towns  take  their  drinking 
water,  and  every  coach  on  every  train  of  cars 
crossing  these  streams  has  a  toilet  which  is 
used  by  typhoid  convalescents.  We  possess 
positive  knowledge  concerning  the  railroads  as 
distributors  of  typhoid.  It  was  once  the  cus- 
tom to  speak  of  a  certain  amount  of  typhoid  as 
the  "  normal  percentage,"  but  now  it  is  known 
that  the  normal  percentage  of  typhoid  is  zero. 

19 


MEDICAL    SOCIOLOGY 

Then  there  are  a  certain  number  of  cases  of 
typhoid  which  acquire  their  infection  within 
the  jurisdiction  of  some  other  municipality,  so 
no  local  health  authority  can  stamp  out  typhoid 
unless  all  do,  or  unless  the  Federal  Government 
lends  a  hand.  Moreover,  we  are  learning  that 
this  disease  very  commonly  is  transmitted  from 
person  to  person ;  nurses  are  particularly  prone 
to  contract  the  disease;  and  with  the  dangers 
inherent  in  the  "  typhoid  carrier  "  we  are  fa- 
miliar. 

At  a  certain  point  the  State  must  come  to  the 
aid  of  the  municipality  if  typhoid  is  to  be  eradi- 
cated. And  finally,  federal  supervision  is  as 
essential  for  the  control  of  the  diseuse  in  a  na- 
tion as  municipal  supervision  is  for  the  control 
of  the  disease  in  a  city.  There  is  so  much  and 
such  rapid  transportation  of  people  and  of 
foods,  and  such  an  intermingling  of  the  same, 
that  typhoid  fever  cannot  be  eradicated  by  each 
city  or  State  acting  separately  and  without  fed- 
eral supervision :  it  is  as  though  each  ward  in  a 
great  city  were  to  attempt  to  solve  its  own  ty- 
phoid problem  without  municipal  control. 

Every  case  of  typhoid  fever  is  an  evidence 
of  the  benighted  state  of  the  civilization  in 
which  it  occurs,  and  of  the  inefficiency  of  the 

20 


THE    SOCIOLOGY    OF   HEALTH 

government.    Typhoid  fever  has  passed  beyond 
the  catalogue  of  diseases ;  it  is  a  crime. 

The  wonder  is  that  so  much  time  has  elapsed 
without  this  country  awakening  to  the  appreci- 
ation of  the  advantages  of  a  central  Depart- 
ment of  Sanitation,  presided  over  by  a  Sani- 
tary General  or  Secretary  of  Public  Health. 
Why  has  it  not  been  done?  The  reasons  are 
various.  They  are:  lack  of  insistence  on  the 
part  of  the  medical  profession;  lack  of  knowl- 
edge of  the  capabilities  of  medical  science  on 
the  part  of  the  public ;  and  a  prevalence  of  the 
general  notion  that  the  object  and  function  of 
the  doctor  is  to  attempt  to  cure  diseases  with 
medicines  more  or  less  noxious,  to  deliver  par- 
turient women,  and  to  perform  the  wonders  of 
surgical  legerdemain.  When  the  statesman  is 
confronted  by  a  question  involving  the  medical 
profession,  there  comes  to  his  mind  at  once  the 
representative  of  that  profession  hastening 
through  the  streets  on  one  or  another  of  these 
errands.  This  has  given  him  a  one-sided  view 
of  the  meaning  of  medicine;  and  it  is  unfortu- 
nate that  this  one-sided  view  prevails  in  our 
legislative  halls.  Many  of  the  men  who  draft 
our  laws  are  of  that  class  which  most  readily 
takes  up  with  the  therapeutic  fads.     The  ig- 

21 


MEDICAL    SOCIOLOGY 

norance  of  the  meaning  and  mission  of  medi- 
cine, displayed  by  our  public  servants  in  high 
places,  is  notorious  and  lamentable. 

The  remedy  lies  in  education  and  concerted 
action  on  the  part  of  scientific  societies  and 
organizations  interested  in  social  betterment. 
Then  comes  the  drafting  of  a  bill  for  either  the 
organization  of  such  a  department,  de  novo,  or 
the  combining  into  a  department  of  health  of 
the  several  branches  of  the  present  government 
which  now  have  to  do  more  or  less  with  mat- 
ters of  public  health.  And  then  we  shall  take 
our  place  in  the  world  as  a  great,  enlightened 
people.^ 

*  The  above  was  published  in  the  jYcw  York  State  Journal  of 
Medicine  in  April,  1907.  History  has  been  making  fast  since  then. 
Congress  has  provided  a  bureau  of  public  health  and  an  hygienic 
laboratory,  President  Roosevelt  and  President  Taft  have  urged 
further  attention  to  the  necessity  for  legislation  for  public  health, 
and  both  the  Republican  and  Democratic  parties,  in  their 
national  platforms  in  1908,  declared  for  further  public-health 
legislation.     But  none  of  these  is  adequate. 


Ill 

A  PLEA   FOR   THE   WELL 

THE  necessity  for  the  family  jDhysician 
and  the  practitioner  of  medicine  will 
continue  indefinitely  to  exist.  Even 
as  the  infective  diseases  become  less  and  less, 
there  will  ever  be  human  ills  and  accidents,  not 
the  least  of  which  are  birth  and  old  age  with 
their  manifold  symptoms.  It  is  not  difficult  to 
believe,  and  surely  it  is  reasonable  to  hope,  that 
the  practitioner  of  the  future  in  his  relation  to 
the  individual  and  the  family  will  be  of  most 
service  in  preventing  disease.  It  is  earnestly 
to  be  wished  that  future  medical  education  will 
give  more  attention  to  the  study  of  the  simple 
things  now  neglected — the  general  care  of  the 
health  of  the  healthy  individual.  We  have  been 
so  busy  with  diseases  and  the  sick  that  we  have 
neglected  the  well.  The  mother  who  seeks  the 
best  information  as  to  what  exercise  her  daugh- 
ter, about  to  enter  college,  shall  take,  what  sort 
of  underclothes  she  shall  wear,  when  she  shall 

23 


MEDICAL    SOCIOLOGY 

bathe,  how  she  shall  ventilate  her  room,  and 
what  she  shall  eat  and  drink,  will  get  little  sat- 
isfaction because  physicians  are  not  agreed. 

The  questions  of  normal  life  are  not  yet  suf- 
ficiently studied.  For  example,  take  the  nurs- 
ing babe.  To  make  women  give  good  milk  is 
really  more  important  than  to  make  cows  give 
good  milk.  Yet  the  research  and  the  volumes 
of  writing  which  have  been  devoted  to  cow's 
milk  as  a  food  for  infants  is  utterly  out  of  pro- 
portion to  that  which  has  been  devoted  to  wom- 
an's milk.  If  the  same  amount  of  consideration 
had  been  given  to  making  mothers  supply  good 
milk  as  has  been  given  to  making  farmers 
supply  good  milk,  the  infant-feeding  problem 
would  be  solved.  A  large  amount  of  scientific 
study,  laboratories,  the  microscope,  the  test 
tube,  sanitary  inspectors,  the  police,  the  Board 
of  Aldermen,  and  the  Legislature,  all  are  in- 
voked to  improve  the  supply  of  cows'  milk  for 
sick  babies ;  but  how  few  of  these  potent  agen- 
cies are  invoked  to  the  simple  end  that  the  nat- 
ural mothers  of  these  infants  should  supply 
them  with  milk !  Might  we  not  wisely  give  more 
consideration  to  the  healthy  babe  before  it  be- 
comes a  sick  babef  Are  our  infants  the  progeny 
of  the  cow  that  the  fons  lactis  naturalis  should 

24 


THE    SOCIOLOGY    OF   HEALTH 

be  so  forgotten?  If  a  mother  does  not  give  the 
milk  the  matter  commonly  is  dismissed  with  re- 
gret, that  "  she  cannot  nnrse  her  child."  She 
may  secure  a  large  variety  of  ineffective  advice, 
varying  with  the  number  of  consultants  whom 
she  employs,  but  in  the  end  she  will  not  be  able 
to  nurse  her  babe — at  least  that  is  the  fate  of 
an  enormous  proportion  of  the  native-bom 
women  in  our  cities.  The  only  alternative  is  to 
"  cast  the  bantling  on  the  rocks,  suckle  him  with 
the  she-wolf's  teat,"  if  we  may  so  designate  the 
cold  and  impersonal  extramaternal  feeding  of 
infants.  This  modem  instance  is  cited  some- 
what at  length  as  an  example  of  the  devotion  of 
medicine  to  the  art  of  fighting  disease  to  the 
neglect  of  encouraging  health,  and  to  the  study 
of  pathology  to  the  neglect  of  physiology.  To 
use  a  homely  expression,  we  are  hell  on  fits. 
The  doctor  has  met  with  wonderful  success  in 
the  treatment  of  diseases ;  and  I  have  no  doubt, 
when  he  sets  himself  to  the  task,  he  will  with 
equal  success  master  the  science  of  health. 

Are  coarse  foods  of  value  in  preserving 
health?  Is  it  true  that  "  four  hours  of  sleep 
before  midnight  are  worth  six  after  midnight "  ? 
Do  we  really  eat  too  much,  or  is  the  cry  but  a 
bugaboo?    Is  fresh  air  so  necessary  for  health 

25 


MEDICAL    SOCIOLOGY 

and  conducive  to  longevity  1  Is  the  minimum  of 
proteid  food  the  optimum?  Is  hypermastica- 
tion  of  value?  Is  a  daily  bath  of  hygienic  vir- 
tue ?  Is  it  really  beneficial  to  take  a  cold  morn- 
ing bath?  Is  exercise  essential  to  perfect 
health?  It  is  to  such  simple  questions  as  these 
that  we  need  to  give  a  scientific  answer,  and 
place  our  knowledge  of  them  on  a  sure  footing. 
At  present  they  are  answered  by  some  in  the 
affirmative,  by  some  in  the  negative.  These  are 
the  questions  which  concern  the  well,  not  the 
sick ;  and  I  shall  always  insist  that,  of  the  two, 
the  well  man  is  of  the  greater  importance  and 
more  entitled  to  the  consideration  of  science.  - 
If  as  much  money  and  enterprise  as  have 
been  bestowed  upon  hospitals  were  devoted  to 
preventing  the  diseases  which  are  treated  in 
hospitals,  the  hospitals  would  be  much  less  im- 
portant figures  than  they  are  at  present.  Here 
lies  a  woman  with  her  lower  abdomen  full  of 
pus,  intestines  matted  together,  an  operation 
scheduled  for  to-morrow  morning,  and  eternal 
invalidism  for  the  rest  of  her  life.  A  pamphlet 
on  venereal  disease  costing  less  than  twenty- 
five  cents  in  the  hands  of  her  husband  at  the 
proper  time,  or  the  proper  instruction  from  a 
respected  source,  would  have  saved  all  of  this. 

26 


THE    SOCIOLOGY    OF    HEALTH 

Let  not  the  cynic  scoff  and  say  pamphlets  and 
education  have  been  tried  and  found  wanting. 
Maybe  his  pamphlets  and  his  education  have. 
But  so  sure  as  man  is  human,  just  so  sure  is  it 
true  that  if  there  is  any  information  that  will 
save  him  misery  and  pain  and  loss  of  love  and 
money,  that  information  he  wants  and  will 
cleave  to  until  death,  and  if  he  does  not  act 
upon  it  it  is  because  he  has  it  not.  Much  infor- 
mation is  given  but  not  received,  heard  but  not 
heeded,  in  which  case  it  is  not  information  at 
all.  It  is  not  so  much  that  we  should  strive  to 
have  more  skill  in  letting  out  pus  as  in  pre- 
venting suppuration.  The  Society  of  Prophy- 
laxis has  more  claim  to  public  esteem  than  the 
Surgical  and  Gynecological  Society,  admirable 
and  valuable  as  it  is.  A  great  man  once  said 
that  were  he  omnipotent  he  would  make  health, 
instead  of  disease,  contagious.  That  omnipo- 
tence is  coming  into  the  hands  of  the  physician 
now. 

Surgery  has  perfected  the  operations  for 
bunions,  ingrowing  toe  nails,  and  hammer  toe, 
but  what  scientific  interest  is  given  to  the  ques- 
tion of  shoes  for  healthy  men?  That  is  the 
more  important  matter.  The  army  has  studied 
it,  but  outside  of  this  men  are  the  slaves  of 

27 


MEDICAL    SOCIOLOGY 

foot-disfiguring  fashion,  and  the  field  for  ex- 
ercising surgical  skill  upon  the  distortions  in- 
duced in  well  men's  feet  is  very  large. 
The  treatment  of  colds  keeps  the  doctor  busy 
through  the  winter  months.  If  the  money  and 
energy  expended  in  compounding,  say,  simply 
those  cough  mixtures  which  do  more  harm  than 
good,  were  devoted  to  the  scientific  study  and 
teaching  of  the  cause  and  prevention  of  colds 
the  well  man  would  then  receive  his  due. 

We  say  that  scientific  attention  is  given  to 
the  matter  of  ventilation  of  schoolrooms  in  our 
new  school  buildings  by  the  engineers  who  con- 
struct them.  Theoretically  that  is  true,  but  as 
a  practical  fact  they  are  poorly  ventilated. 
Well  children  go  into  these  rooms  and  come 
out  with  headaches,  adenoids,  and  colds — the 
products  of  imperfect  ventilation.  The  ventila- 
tion problem  is  worked  out  on  paper,  but  it 
does  not  stand  the  clinical  test.  What  would  we 
think  of  a  medical  treatment  being  applied  to 
the  sick  which  was  such  a  farce  as  this? 

The  medical  profession  has  been  instrument- 
al in  inaugurating  a  great  system  of  tubercu- 
losis education  by  means  of  public  lectures, 
pamphlets,  and  exhibits.  The  city  dwellers 
have  been  most  in  need  of  these,  and  they  have 

28 


THE    SOCIOLOGY    OP    HEALTH 

been  of  infinitely  greater  value  to  the  well  than 
to  the  sick.  But  this  is  only  the  first  step  in 
the  campaign  against  tuberculosis.  Knowl- 
edge becomes  sterile  if  it  cannot  be  applied,  and 
how  can  the  crowded  tenement  dwellers  of  the 
great  cities  take  advantage  of  this  knowledge? 
How  can  a  balcony  be  slept  upon  if  there  is  no 
balcony?  How  can  windows  be  opened  if  there 
are  no  windows'?  Medicine  has  started  this 
campaign  for  the  saving  of  the  well ;  the  State 
must  take  it  up  and  continue  it,  but  we  know 
that  its  ultimate  solution  is  an  economic  one. 
When  one  sixth  of  the  families  in  one  neighbor- 
hood in  New  York  City  live  each  in  a  single 
room,  and  one  third  of  the  families  live  in  two 
rooms — many  of  which  are  dark  and  squalid — 
when  these  miserable  quarters  cost  the  occu- 
pants for  rent  one  third  of  the  wages  earned 
by  the  men  of  the  families,  when  these  people 
cannot  buy  food  and  fuel  economically  because 
they  must  be  bought  in  very  small  quantities, 
then  the  plea  that  we  make  for  the  well  must 
be  also  upon  an  economic  basis.  It  is  to  this 
end  that  our  campaign  of  education  must  be 
directed. 

Human  health  must  be  regarded  as  of  too 
great  value  for  the  community  to   permit  a 

29 


MEDICAL    SOCIOLOGY 

landlord  to  wring  out  of  his  tenants  for  rents 
twelve  per  cent  on  his  investment.  Coal 
bought  by  the  pailful,  because  there  are  no 
facilities  for  storing  it,  costs  from  twenty- 
one  to  twenty-eight  dollars  a  ton.  We  have 
laws  against  usurious  charges  for  money,  but 
none  for  usurious  charges  for  tenement  houses. 
Is  money  so  much  more  precious  and  worthy  of 
protection  than  human  lives?  It  is  this  usuri- 
ous advantage  which  can  be  taken  of  the  poor 
and  ignorant  that  makes  the  protection  of  the 
well  difficult  in  the  crowded  cities.  The  cities 
are  practicing  wastefulness  in  allowing  their 
inhabitants  to  be  rented  unhygienic  dwellings. 
Model  tenements  are  an  economic  necessity. 

No  plea  for  the  well  is  complete  unless  it  calls 
attention  to  these  economic  needs  which  affect 
the  health  of  the  people.  In  the  first  place  the 
whole  responsibility  for  the  child  should  not 
rest  upon  the  parents  alone.  The  coming  into 
the  world  of  a  child  is  of  more  importance  to 
the  State  than  is  the  advent  of  an  immigrant, 
a  criminal,  or  a  lunatic,  yet  the  State  gives  its 
serious  attention  to  the  last  three  but  leaves 
the  child  to  the  mercy  of  its  parents,  who  may 
be  ignorant  and  vicious.  These  things  should 
ultimately  receive  the  attention  of  the  State: 

30 


THE    SOCIOLOGY    OF    HEALTH 

the  physically  and  mentally  unfit  shall  not 
breed  children;  and  children  shall  be  bom  di- 
rectly into  the  custody  of  society,  and  society 
shall  demand  that  they  receive  the  attentions 
necessary  to  make  them  healthy  and  helpful. 
If  the  parents  cannot  or  do  not  provide  for 
them  the  State  shall.  If  it  does  not  do  this  it 
should  not  have  allowed  them  to  be  conceived. 
The  most  important  things  for  the  community 
to  take  care  of  are  not  the  trees  or  the  animals 
in  the  park  but  the  human  beings.  If  we  find 
a  tree  in  a  public  park  affected  by  some  disease 
the  people  know  where  to  place  the  responsibil- 
ity: it  rests  upon  some  one  whom  they  ap- 
pointed ;  but  a  little  child  may  grow  straight  or 
crooked,  it  is  at  the  mercy  of  parents — they  are 
self-appointed  custodians.  Whether  it  is  by  a 
pension  for  mothers,  or  by  an  insured  stipend 
for  the  child,  or  by  State  supervision,  the  re- 
sponsibility for  maintaining  the  child  in  health 
must  some  day  be  taken  hold  of  by  the  people. 
Diseases  and  bad  conditions  will  continue  to 
incapacitate  the  healthy  until  the  well  man  re- 
ceives the  consideration  which  his  importance 
and  value  to  the  community  merits.  Some  day 
we  shall  have  scientific  studies  of  human  health. 
Papers  before  societies  on  these  subjects  will 
4  31 


MEDICAL    SOCIOLOGY 

be  common.  Every  medical  school  will  teach 
hygiene  (not  merely  have  a  nominal  chair),  and 
the  study  of  health  will  be  regarded  as  of 
greater  value  than  the  study  of  disease.  This 
most  important  scientific  field  yet  remains  un- 
developed. Biologists  are  needed  to  study  man 
to  the  utmost  possibilities  of  human  knowledge. 
It  was  once  the  custom,  in  a  time  of  medical 
unenlightenment,  for  the  sick  man  to  ask  the 
advice  of  some  wise  layman,  but  now  he  seeks 
the  physician.  It  is  now  the  custom  in  mat- 
ters of  personal  hygiene  to  take  counsel  with 
some  layman  who  exemplifies  good  hygiene,  but 
the  day  draws  near  when  medical  men  will  be 
authorities  on  health  as  well  as  on  disease.  Just 
in  proportion  as  the  medical  profession  be- 
comes proficient  and  learned  in  the  art  of  main- 
taining health,  in  just  that  proportion  will  be 
increased  its  power  as  a  force  in  the  public  life. 
The  State,  the  people  as  a  whole,  demand  in- 
crease of  individual  efficiency.  And  the  medical 
profession  has  it  in  its  power,  to  a  greater  de- 
gree than  any  other  class  of  men,  to  help  toward 
that  very  thing — increase  of  the  efficiency  of  the 
individual.  He  who  preserves  the  strong  is  re- 
membered when  he  who  saves  the  weak  is  for- 
gotten.   Those  who  are  looked  to  only  in  time 

32 


THE    SOCIOLOGY    OP    HEALTH 

of  trouble — the  old-time  doctor,  the  money 
lender,  the  insurance  company,  the  priest,  the 
undertaker — all  may  be  respected,  but  they  are 
not  honored  by  strong  and  virile  and  independ- 
ent men.  The  weaker  side  of  the  body  politic 
honors  them,  but  public  opinion  is  the  opinion 
of  the  strong.  When  the  medical  profession 
becomes  the  champion  of  the  strong  man,  of 
the  growing  youth,  and  of  the  lusty  babe,  as 
well  as  it  has  for  countless  generations  been 
the  champion  of  the  sick  and  the  distressed  and 
the  puny,  then  shall  it  conduct  humanity  to  vic- 
tories yet  undreamed,  then  shall  the  physician 
be  not  only  helper  but  he  shall  be  leader  also. 


IV 

SOME    MEDICAL   ASPECTS    OF    CIVILIZATION 

I  SHALL  not  attempt  to  define  civilization 
— ^it  is  a  rather  elusive  state — but  I  shall 
insist  that  it  implies  betterment  of  per- 
sonal and  social  conditions.  It  must  make  for 
happiness,  it  should  help  men,  or  it  is  not 
civilization.  We  must  beware  of  the  disposi- 
tion to  regard  peoples  whose  manners  and  cus- 
toms are  different  from  our  own  as  being  not  so 
civilized  as  we.  These  very  people  may  have 
as  good  cause  to  judge  us  likewise.  Civiliza- 
tion is  to  the  community  what  culture  is  to  the 
individual,  and  since  society  is  an  aggregation 
of  persons  it  all  reduces  itself  to  a  matter  of 
the  individual. 

There  is  an  injustice  done  this  expression  in 
that  we  are  prone  to  regard  as  the  attributes  of 
civilization  the  things  to  which  we  are  accus- 
tomed. In  other  words,  we  think  that  we  are 
the  civilized  people,  whoever  we  are.  A  man 
who  has  been  li\ing  in  the  woods  with  the  In- 

34 


THE    SOCIOLOGY    OF    HEALTH 

dians  looks  at  his  moccasins  and  says :  "  Well, 
I  shall  be  glad  to  get  back  to  Broadway  and  into 
a  pair  of  civilized  shoes."  By  that  he  means  ex- 
changing the  comfortable  moccasins  for  a  pair 
of  sharp-pointed,  stiff  patent-leather,  foot-de- 
forming shoes  which  require  to  be  "  broken  in." 
The  London  girl  whom  circumstances  marooned 
among  the  Swiss  mountains  and  clothed  in 
short  skirts  and  a  loose  bodice,  exclaims  "  I 
shall  be  glad  to  get  back  home  and  into  civilized 
clothes  again."  She  means — go  up  to  London 
and  see  for  yourself! 

We  expect  these  things ;  civilization  hangs  on 
the  edge  of  savagery.  The  fact  that  a  society 
cultivates  many  of  the  civilizing  virtues  hardly 
justifies  it  in  designating  all  of  its  attributes  as 
the  qualities  of  civilization.  It  happens  that 
the  majority  stand  behind  much  of  the  sav- 
agery and  declare  that  it  shall  have  the  name 
of  civilization.  This  is  true  of  the  Broadway 
shoe  and  of  the  London  corset.  Civilization  in 
the  popular  acceptance  is  much  a  matter  of 
custom  rather  than  of  good,  of  tradition  and  su- 
perstition rather  than  of  knowledge  and  cul- 
ture. It  is  illustrated  by  the  mob  which  de- 
stroyed the  library  and  apparatus  of  Joseph 
Priestly,  by  the  murder  of  Michael  Servetus, 

35 


MEDICAL   SOCIOLOGY 

and  by  the  little  threatening  band  which  waited 
outside  of  McDowell's  house  while  he  per- 
formed the  first  removal  of  an  abdominal 
tumor. 

An  independent  citizen  of  Washington  with 
a  good  head  of  healthy  hair  wears  no  hat,  and 
he  is  hooted  by  the  bald-headed,  derby-crowned 
scions  of  Washington  civilization  as  he  passes 
to  and  from  his  daily  work.  I  know  a  woman 
who  might  have  a  so-called  "  luxuriant  head  of 
hair,"  but  she  keeps  it  cut  off  at  a  level  with 
the  lower  angle  of  her  shoulder  blades.  That 
gives  her  an  abundance  for  coiffure  purposes, 
to  pin  her  hat  to,  and  to  look  well.  Still,  in  the 
civilization  in  which  she  lives,  women  take  pride 
in  carrjdng  about  with  them  as  much  as  pos- 
sible of  this  particular  excretion.  Some  carry 
two  or  three  pounds  of  it  on  their  heads — 
weighing  ahnost  as  much  as  their  livers.  If  a 
woman  can  sit  on  her  hair  she  is  proud  of  it. 
The  more  there  is  of  this  mass  of  stuff  the  more 
time  it  requires  for  its  care.  It  should  give 
about  as  much  satisfaction  to  have  an  unwieldy 
mass  of  hair  as  it  should  to  have  long  and  un- 
wieldy finger  nails.  It  is  a  part  of  the  agreed- 
upon  concomitants  of  ci\T.lization.  Pekin  is  not 
far  from  New  York. 

36 


THE    SOCIOLOGY    OF   HEALTH 

Now  let  us  come  a  little  closer  home  to  the 
medical  profession.  There  lies  before  me  a 
medical  book  by  an  eminent  obstetrician  in 
which  I  read  that  "  the  rapid  pace  of  modem 
life  is  more  and  more  rendering  the  nursing 
of  infants  distasteful  and  even  annoying  to 
many  mothers,  and  this  is  especially  so  as  we 
ascend  the  scale  of  social  life."  Again,  "  The 
advancements  of  civilization,  especially  in  our 
cities  and  among  cultivated  people,  are  render- 
ing child  bearing  more  and  more  difficult  and 
depriving  the  infant  of  maternal  interest." 
These  statements  are  grossly  and  horribly  false. 
It  is  true  that  "  the  rapid  pace  of  modem  life 
is  more  and  more  rendering  the  nursing  of  in- 
fants distasteful  and  even  annoying  to  many 
mothers,"  but  that  "  this  is  especially  so  as  we 
ascend  the  scale  of  social  life  "  I  say,  a  thou- 
sand times,  No !  Our  books  on  obstetrics  and 
gynecology  pass  this  error  along.  I  wish  they 
would  not.  The  mother  who  does  not  love  her 
babe  has  not  ascended  the  social  scale.  The 
women  who  represent  the  real  civilization,  who 
can  justly  be  said  to  be  high  in  the  social  life, 
are  they  who  keep  their  bodies  in  health,  who 
conceive  in  joy,  and  who  bring  forth  in  glad  ex- 
pectancy their  offspring  to  be  cherished  and 

37 


MEDICAL    SOCIOLOGY 

nourished  and  guided  by  mother  love.  Our 
writers  have  confused  civilization  with  bridge 
parties,  earrings,  high  heels,  the  theater,  and 
feminine  fluffiness.  Let  medical  literature  at 
least  cease  from  this  error.  A  group  of  females 
bemoaning  pregnancy  as  an  "  accident "  are 
not  even  mounted  on  the  social  scale.  The  pug- 
dog  companionship,  fingers  encrusted  with  jew- 
els, idleness  and  ennui  are  not  the  signs  of  cul- 
tivation. 

Civilization  and  social  advancement  are  mak- 
ing women  more  healthful,  more  moral,  more 
happy,  more  interested  in  the  important  things 
of  life;  and  more  useful;  if  they  are  not  doing 
this  they  shall  not  have  that  name.  They  are 
bringing  the  pregnant  woman  out  of  her  "  nurs- 
ery wrapper  "  and  brooding  seclusion,  and  giv- 
ing her  her  wonted  exercise  and  open  air  and 
healthful  occupation.  The  pregnant  woman 
who  fills  her  soul  with  fear  and  secludes  herself 
as  an  invalid  becomes  an  invalid,  but  in  so 
doing  she  is  not  displaying  the  attributes  of  an 
advancing  civilization. 

A  few  years  ago  when  it  was  fashionable  to 
be  pale  and  languid  a  lady  from  Chicago,  as 
she  tied  two  thicknesses  of  veils  over  her  face 
before  stepping  into  the  carriage  for  a  drive, 

38 


THE    SOCIOLOGY    OF    HEALTH 

said  to  her  weather-browned  hostess :  "  If  you 
went  in  society  you  would  have  to  take  care  of 
your  complexion,  too !  "  Here  are  "  society  " 
and  the  "  social  scale  "  again ;  but  the  weather- 
browned  woman,  who  had  cast  out  the  artificial 
from  her  life,  was  the  higher  of  the  two  in  this 
much  talked-of  "  social  scale." 

On  one  of  those  rare  days  in  the  early  part 
of  April,  when  the  air  is  clear  and  the  sun  is 
making  the  old  earth  warm  again,  when  nature 
proclaims  the  end  of  winter's  slumber,  and  the 
buds  are  swelling  with  awakening  life — on  one 
of  those  great  resurrection  days,  I  saw  two 
women,  arrayed  with  short  skirts  and  stout 
shoes,  set  off  for  the  woods  with  their  children, 
to  rejoice  in  the  discoveries  of  the  first  signs 
of  life  at  the  glad  festival  of  the  awakening  of 
the  living  things.  On  that  same  bright  day,  I 
looked  into  a  gorgeous  parlor.  The  shades 
were  drawn  to  exclude  the  light  of  day;  arti- 
ficial illumination  threw  its  pallid  pall  upon  the 
scene;  the  air  was  close  and  pregnant  with 
infinite  migraine  possibilities;  at  a  score  of 
tables  sat  fourscore  of  women,  magnificent  be- 
yond description;  their  children  were  in  the 
care  of  the  nurse  at  home;  the  bowels  of  the 
earth  had  yielded  up   the  brightest  gems   to 

39 


MEDICAL    SOCIOLOGY 

adorn  their  throats  and  fingers;  precious 
pearls,  filched  from  the  voiceless  oyster,  nes- 
tled as  though  at  home  against  their  shell-like 
ears  or  hung  like  tears  of  protest  from  the 
holes  that  defiled  their  fair  lobes;  some  dis- 
played the  purchased  blush  for  health  that  con- 
cealed the  pallid  cheek;  the  richest  fabrics  of 
the  loom  lent  to  the  eye  the  dazzle  of  their 
color  and  to  the  ear  the  faint  rustle  of  their 
richness ;  fourscore  of  heads  were  crowned  with 
wondrous  and  bizarre  productions  of  milliners' 
ingenuity,  made  still  more  glorious  by  resplen- 
dent pluniage  plucked  from  the  warm  bodies 
of  birds  of  paradise;  the  air  was  hushed; 
this  awe-inspiring  sight,  I  was  informed,  was 
"  bridge  " ;  and  I  marveled  and  wondered  if  I 
were  now  beholding  the  veritable  pons  over 
which  sages  for  all  ages  had  cudgeled  their 
dull  asses.  Then  my  mind  turned  to  the  two 
women  out  under  the  blue  sky,  pressing  the 
soft,  warm  earth  beneath  their  feet,  breathing 
in  the  precious  air  of  heaven,  rejoicing  in  the 
miracles  of  the  springtime,  with  merry  chil- 
dren eager  to  read  the  great  message  written 
in  nature's  missal — and  I  knew  the  race  of  man 
was  saved. 

Let  us  place  the  right  values  on  things  so 
40 


THE    SOCIOLOGY    OF    HEALTH 

that  our  literature  may  stand  the  scrutiny  of 
time.  Let  us  not  accept  false  estimates  from 
the  hands  of  society.  Whatever  pertains  to  the 
health  of  people  is  within  the  jurisdiction  of 
the  medical  profession,  and  it  is  our  duty  to 
reconcile  with  the  advancements  of  civilization 
whatever  makes  for  healthfulness. 

It  also  is  our  bounden  duty  to  declare  as  un- 
civilized and  uncivilizing  the  influences  which 
make  women  less  useful  and  less  loving  and  lov- 
able as  mothers  and  wives. 


V 

HEALTHFULNESS   AND    HAPPINESS 

HAVE  recently  had  a  friend  make  the 
statement  that  he  would  rather  be  happy 
than  healthy — this  in  connection  with  the 
harm  that  tobacco  was  doing  him.  He  pre- 
ferred to  suffer  the  physical  ills  entailed  by  to- 
bacco than  to  sacrifice  the  pleasure  of  the  fra- 
grant plant.  That  is  his  affair.  It  is  a  terse 
way  of  saying  that  it  is  better  to  do  what  one 
wants  to  do  without  considering  its  healthful- 
ness  or  unhealthfulness  than  it  is  to  do  dis- 
agreeable things  for  health's  sake.  This  is  a 
perfectly  reasonable  view.  One  generally  does 
what  he  wants  to,  and  that  is  usually  the  most 
sensible  thing  to  do.  That  is  a  man's  birthright 
as  soon  as  he  is  strong  enough  to  enter  into  the 
inheritance  of  his  own  and  take  possession.  As 
a  child  he  has  to  do  what  some  one  else  thinks 
he  should  do  —  what  some  one  else  thinks  is 
good  for  his  health  or  for  their  happiness.  But 
when  his  ego  has  grown  strong  there  comes  into 

42 


THE    SOCIOLOGY    OF    HEALTH 

play  der  Einzige  und  sein  Eigentum.  Then, 
too,  there  is  a  disposition  to  take  the  gambler's 
chance.  One  often  violates  a  law  of  health  hop- 
ing that  the  retribution  may  not  be  forthcom- 
ing. Sometimes  it  is  not,  and  he  becomes  em- 
boldened and  takes  a  chance  again. 

Shall  I  take  a  cold  bath  on  a  winter's  morn- 
ing or  not"?  Shall  I  walk  to  the  office  or  ride? 
Shall  I  decliae  to  take  a  couple  of  drinks  with 
a  convivial  friend?  Shall  I  be  healthy  or  shall 
I  be  happy?  These  are  the  questions  often 
asked.  And  one  naturally  decides  for  happi- 
ness, for  it  is  that  for  which  we  live.  The  ob- 
ject of  life  is  happiness,  not  health.  We  are  not 
living  for  the  sake  of  growing  healthy,  we  are 
living  with  happiness  in  \T.ew.  The  man  who 
makes  healthfulness  his  aim  in  life  might  be  a 
fine  specimen  of  a  brute,  but  he  would  be  a 
pretty  poor  sort  of  a  man.  But  just  here  comes 
the  duty  of  medicine  to  humanity;  that  duty  is 
to  make  the  incentive  to  happiness  and  health- 
fulness  grow  toward  each  other  until  finally 
they  come  together  and  coalesce.  Then  we  shall 
find  happiness  in  doing  what  is  healthful,  and 
health  in  happiness. 

This  consummation  is  in  process  of  evolution. 
One  does  not  go  to  breakfast  without  having 

43 


MEDICAL    SOCIOLOGY 

brushed  liis  teeth,  although  it  is  a  time-consum- 
ing and,  in  itself,  in  no  wise  a  pleasurable  task. 
We  also  bathe  and  keep  our  bodies  clean.  Our 
ancestors  a  few  generations  ago  gave  little 
heed  to  either  of  these  operations.  Knowledge 
of  their  value  to  us  as  individuals  makes  us 
perform  with  happiness  tasks  which  otherwise 
would  be  disagreeable.  The  beautiful  men  and 
women  of  the  age  of  chivalry,  of  whom  the  po- 
ets have  sung  so  wonderfully,  were  notoriously 
dirty  as  to  their  bodies,  although  classic  art 
has  belied  them  sweet  and  clean.  Cleanliness  in 
Christendom  is  a  recent  conception.  The  in- 
fluence of  medical  science  upon  human  progress 
is  destined  to  bring  into  the  circle  of  happiness 
all  those  things  which  make  for  health,  for 
health  is  one  of  the  most  important  prere- 
quisites of  happiness. 

This  is  just  the  process  which  is  going  on 
with  regard  to  morality,  and  has  reached  a  high 
state  of  development  among  the  most  cultivated 
people.  The  old  question  used  to  be,  Shall  I 
be  good  or  happy?  If  I  am  good  I  shall  miss 
lots  of  fun.  Education  has  brought  morality 
and  happiness  so  close  together  that  now  they 
touch.  The  foundation  stones  of  happiness  are 
hewn  in  the  quarry  of  morality.    Happiness  is 

44 


•    THE    SOCIOLOGY    OF   HEALTH 

comparatively  little  sought  for  in  immorality. 
Wise  men  have  learned  that  the  best  happi- 
ness must  be  consistent  with  morality.  Of 
course  the  consummation  is  not  yet  quite  com- 
pleted ;  that  would  mean,  I  think,  what  is  called 
the  millennium. 

This  development  of  healthful  happiness 
must  go  hand  in  hand  with  moral  happiness. 
Morals  do  not  thrive  well  in  unhealthy  bodies. 
Solomon  and  David  are  horrible  examples  of 
retributive  morality.  The  compulsory  moral- 
ity of  old  men,  who  are  the  wrecks  of  youthful 
sinners,  is  not  the  real  thing,  although,  of 
course,  better  than  nothing.  A  man  in  jail  can- 
not steal,  nor  can  a  sexual  wreck  be  a  roaring 
libertine.  Desirable  morality  is  of  the  healthy 
and  vigorous  type.  The  same  is  true  of  hap- 
piness. Healthful  happiness — it  is  that  toward 
which  medical  science  is  directed.  We  are  aim- 
ing toward  the  state  of  enlightenment  in  which, 
if  the  walk  to  the  office  is  the  more  healthful  it 
will  be  preferred  to  the  ride,  in  which  the  harm- 
ful tipple  will  be  declined  with  pleasure,  and 
in  which  my  friend  will  value  his  health  more 
than  his  pipe.  Harmless  pleasures  will  take 
the  place  of  harmful  ones,  and  health  and  hap- 
piness will  go  hand  in  hand. 

45 


VI 

EXERCISE   AND    HEALTH 

AN  Eastern  potentate  of  great  age  and  vig- 
L^k  orous  health,  who  sat  watching  some 
-A.  J^  Englishmen  playing  polo,  asked  if  the 
young  men  were  really  so  poor  that  they  could 
not  hire  people  to  do  that  for  them.  A  modern 
philosopher  has  observed  that  work  is  work  if 
you  are  paid  to  do  it ;  it  is  play  if  you  pay  to  be 
allowed  to  do  it. 

There  is  much  confusion  between  strength 
which  cati  be  measured  by  foot  pounds  and 
strength  which  means  vitality  and  can  be  meas- 
ured in  resisting  disease.  The  athletic  exhibit 
in  the  physical  culture  advertisement  whose 
back  looks  like  a  corduroy  road,  and  the  plain 
citizen  who  prefers  arguing  with  a  burglar  to 
tossing  him  through  the  window,  and  who  is 
never  sick  till  he  turns  seventy,  are  two  very 
different  exhibits  of  strength.  Good  health 
should  be  the  criterion.  That  is  what  we  are 
seeking — not  lifting  power. 
All  men  are  constituted  differently  so  far  as 
46 


THE    SOCIOLOGY   OF   HEALTH 

exercise  is  concerned.  For  health's  sake  a  man 
should  take  as  much  exercise  as  he  needs.  Most 
of  us  need  exercise.  It  is  an  hereditary  neces- 
sity. Our  organism  is  constituted  for  exercise, 
and  we  must  have  it  or  suffer  a  certain  degree 
of  unbalancing  of  our  system.  This  is  neces- 
sary for  the  reason  that  our  ancestors  for  hun- 
dreds and  thousands  of  years  took  exercise. 
Their  vocations  were  acts  of  toil  and  manual 
labor.  Huntiag  food,  fighting  off  enemies,  till- 
ing land,  and  building  houses  are  the  functions 
for  the  performance  of  which  we  have  inherited 
muscles.  Our  good  health  demands  that  we 
shall  to  a  certain  degree  live  up  to  our  inten- 
tions. It  is  only  since  the  conditions  which 
make  for  inequality  in  social  standing  have  ap- 
peared that  a  part  of  the  community  labors  and 
another  part  is  exempted  from  labor.  Much  of 
our  so-called  education  is  patronized  with  the 
view  of  securing  exemption  from  labor.  Our 
public-school  system  is  defective  in  this  quality : 
it  too  often  inspires  youth  with  the  ambition 
to  escape  work.  If  a  man  is  uneducated  he 
must  labor;  if  he  is  educated  he  may  earn  his 
livelihood  manipulating  the  products  of  the  la- 
bor of  others.  These  things  will  be  adjudicated 
by  and  by. 

5  47 


MEDICAL   SOCIOLOGY 

The  older  civilizations  in  fertile  countries, 
where  food  has  been  abundant  and  where  pros- 
perity has  followed  trade,  have  gradually  elim- 
inated in  many  instances  the  necessity  for  ex- 
ercise of  the  bone-moving  muscles.  We  of  the 
Western  world  are  yet  too  near  the  soil  to  do 
this.  Most  of  us  need  not  go  back  more  than 
a  generation  or  two  to  find  our  ancestors  delv- 
ing with  bone  and  sinew.  What  is  true  of  the 
race  is  true  of  the  individual.  It  is  not  good 
for  the  health  of  the  brawny  blacksmith  to  quit 
his  anvil  and  turn  bookkeeper.  Nor  can  the 
children  of  the  toiling  lineage  live  in  muscular 
idleness.  Each  requires  exercise  in  some  sort 
akin  to  his  hereditary  wont.  His  best  physical 
health  demands  it. 

But  lack  of  exercise  is  not  the  only  change 
made  by  the  man  who  becomes  sufficiently  cul- 
tured to  be  able  to  escape  physical  labor.  He 
also  exchanges  the  free  and  open  air  of  his  an- 
cestors for  the  confinement  of  the  office,  and  he 
adds  the  stress  and  strain  of  mental  competi- 
tion for  livelihood  which  his  ancestors  knew 
not,  at  least  as  a  necessity,  but  only  incidentally 
as  a  pastime.  Thus  the  man  who  labors  not 
with  his  hands,  if  he  would  follow  the  tend- 
encies of  his  race  or  family,  which  must  have 

48 


THE    SOCIOLOGY   OF   HEALTH 

been  salutary  because  they  have  produced  him, 
needs  exercise,  free  and  open  air,  and  relief 
from  the  stress  of  mental  competition.  These 
three  things  he  needs,  and  he  is  not  wise  unless 
he  gives  himself  the  advantage  of  them  regu- 
larly and  systematically.  Unless  he  does,  his 
family  line  must  pay  the  penalty,  and  end  with 
him  or  with  his  emasculated  offspring. 

The  city  is  a  trap  in  which  is  caught  the  eagle 
who  has  soared  the  air  and  dwelt  amid  the 
mountain  cliffs  for  countless  generations.  The 
free  expanse  of  earth  and  sky  have  been  his 
and  his  fathers.  Now  he  is  caged — a  mighty 
specimen.  Call  him  "  magnate  "  or  "  Napoleon 
of  finance  "  or  "  clerk,"  or  what  you  will,  he  has 
in  his  blood  the  impetus  of  a  thousand  genera- 
tions and  the  memories  of  the  free  air  and  sky 
to  give  him  strength ;  but  keep  him  caged  in  the 
city,  and  his  breedings  will  be  but  barnyard 
fowl,  which  will  perish  and  melt  away. 

The  Anglo-Saxon  business  man  or  profes- 
sional man  needs  not  only  some  exercise,  but  he 
needs  it  in  the  open  air.  I  am  not  sure  but  that 
the  latter  is  even  more  important  than  the 
former.  It  is  quite  true  that  much  of  the  bene- 
fit attributed  to  exercise  belongs  to  fresh  air 
and  forgetfulness  of  mental  competition  and 

49 


MEDICAL    SOCIOLOGY 

business  cares.  A  day's  target  shooting,  lying 
on  the  ground,  gives  results  apparently  as  good 
as  a  day  at  golf.  And  of  all  the  miserable 
makeshifts  of  exercise  bowling  is  the  worst, 
when  practiced,  as  it  usually  is,  in  an  illy  ven- 
tilated basement  in  artificial  light  and  dust  and 
smoke. 

This  whole  matter  of  exercise  and  recreation 
requires  orientation.  It  needs  to  receive  sci- 
entific study,  and  to  be  presented  to  the  peo- 
ple as  a  part  of  their  education.  Witness  the 
unwholesome  struggles  for  recreation  and  ex- 
ercise indulged  in  by  the  hordes  flocking  to  the 
summer  amusement  places.  How  deficient  in 
education  upon  this  important  subject  is  this 
sweating,  peanut-eating,  gewgaw-besxjangled, 
beer-consuming  throng.  The  poor  man,  like  the 
rich  man,  too  often  prizes  his  recreation  ac- 
cording to  the  cost.  The  sport  which  costs 
money  is  the  thing. 

.1  should  like  to  see  the  rich's  man  recreations 
turned  to  greater  usefulness.  There  are  use- 
ful recreations  which  give  as  good  exercise  as 
the  nonproductive  exercises.  A  man  who  plays 
eighteen  holes  of  golf — even  though  he  indulge 
in  no  stronger  expletives  than  "  Tush,  tush !  " — 
has  used  enough  energy,  if  turned  into  useful 

50 


THE    SOCIOLOGY    OF    HEALTH 

chaimels,  to  cultivate,  say,  an  acre  of  potatoes 
or  to  split  enough  wood  to  keep  a  single  fam- 
ily warm  for  a  month  in  winter.  These  are 
practical  and  useful  employments.  To  say  that 
a  man  has  taken  enough  exercise  if  converted 
into  foot  pounds  to  raise  himself  5,000  feet 
is  scientific,  but  a  man  does  not  want  to  be 
raised  5,000  feet.  But  we  do  need  potatoes 
and  fire  wood  for  the  winter.  Trimming  shrub- 
bery, laying  walls,  mowing  grass,  digging  ditch- 
es, making  roads,  hoeing  in  the  garden,  plant- 
ing seeds,  cutting  weeds,  planting  trees  are  as 
good  exercise  as  golf ;  and  all  are  useful.  I  am 
familiar  with  the  satisfaction  in  winning  a  close 
set  of  tennis ;  I  know  the  joy  in  golf  in  getting 
off  the  long,  low  drive  that  goes  and  keeps  on 
going  and  contributes  to  the  beating  of  the 
bogey ;  I  know  the  calm  contentment  in  making 
bull's-eyes  at  a  thousand  yards;  I  love  the  ex- 
hilaration of  a  dash  in  the  saddle  through  the 
still  woods  or  across  the  plains;  I  know  the 
joy  of  holding  the  tiller  to  a  spanking  breeze — 
but  all  these  are  lacking  in  that  quality  which 
craves  results — real  results,  results  that  help 
more  than  the  doer  alone.  And  as  I  contem- 
plate the  efforts  which  accomplished  nothing 
but  pleasure  for  me  alone,  as  I  think  of  the 

51 


MEDICAL   SOCIOLOGY 

rides  that  carried  nothing  and  ended  but  in 
turning  back  to  the  place  whence  I  came,  and 
then  as  I  contemplate  the  multitudes  of  human 
needs  which  might  be  supplied  by  healthful 
activities,  those  who  want  and  to  whom  the 
things  needed  might  be  carried,  the  barren 
fields  waiting  for  the  hand  to  cultivate  them, 
the  desolate  places  crying  to  be  cleansed,  all  of 
the  faults  that  can  be  remedied  only  by  the  will- 
ing hand  and  strong  arm,  I  am  convinced  that 
a  waste  of  muscular  energy  is  as  prodigal  as  a 
waste  of  mental  energy  or  of  money.  When 
the  golf  and  the  tennis,  the  saddle  and  the  till- 
er, are  forgotten  I  shall  cherish  the  memory 
of  the  real  sport  in  soil  turned  by  the  plow, 
stone  fences  laid,  new  land  cleared,  red  apples 
carried  to  the  market,  snow  shoveled,  wood 
chopped,  and  sweet  hay  stored  in  the  mow. 

The  man  who  can  afford  to  engage  in  unpro- 
ductive exercise  finds  joy  in  the  human  weak- 
ness of  prodigality.  The  spendthrift  who  lights 
his  cigarette  with  a  twenty-dollar  bill  has  a 
similar  pleasure  to  that  which  he  finds  in  knock- 
ing a  rubber  ball  around  a  field,  consuming 
time,  material,  and  energy  with  nothing  to 
show  for  it;  the  great  majority  of  mankind  can- 
not afford  to  do  it.    What  we  much  need  is  the 

52 


THE    SOCIOLOGY    OF    HEALTH 

competitive  spirit  and  the  spirit  of  joy  and  play 
introduced  to  a  greater  degree  in  productive 
work.  It  is  done  to  a  certain  degree ;  it  can  be 
done  more. 

There  are  sociologists  who  contend  that  there 
is  not  enough  work  for  those  who  need  it  and 
who  must  have  it  in  order  to  live,  and  they 
would  stay  the  hand  of  the  rich  man  from  work. 
This  is  false  doctrine.  They  have  sought  for 
reasons  in  the  wrong  place.  The  whole  out-of- 
doors  is  crying  for  the  hand  of  man  to  cleanse 
it  and  to  mold  it  into  shapes  more  useful  and 
beautiful.  And  so  long  as  there  are  hungry 
people  and  uncultivated  fields,  so  long  as  there 
are  empty  wood-boxes  and  unchopped  wood, 
so  long  as  there  are  unsupplied  wants,  there  is 
work  to  be  done.  The  man  who  pours  a  good 
can  of  milk  into  the  sewer  should  be  touched  by 
the  same  compunctions  of  prodigality  as  the 
unproductive  youth  who  pours  a  day  of  good 
energy  into  the  game  of  golf. 

I  would  not  discourage  the  joy  of  play  among 
children,  nor  play  with  them  and  for  them ;  nor 
would  I  deny  such  play  to  the  man  who  works 
with  his  brain  and  cannot  secure  access  to  pro- 
ductive recreation;  nor  to  the  man  who  works 
with  both  head  and  hand  indoors  and  out  if  he 

53 


MEDICAL    SOCIOLOGY 

finds  joy  and  help  in  the  relaxation  of  play; 
nor  would  I  discourage  altogether  the  athletic 
sports  that  encourage  health  and  interest  in 
strong  and  supple  bodies.  This  is  play  which  is 
as  productive  as  restful  repose  is.  But  I  re- 
turn to  the  proposition  that  for  most  of  this 
play  useful  outdoor  work  could  be  substituted. 
The  play  is  necessary  because  of  failure  to 
engage  in  such  work.  The  best  kind  of  labor  is 
useful  labor,  and  the  best  kind  of  play  is  useful 
play.  Such  labor  becomes  play  if  entered  into 
in  the  right  spirit.  Let  us  turn  our  faces  toward 
the  day  when  we  shall  have  more  of  useful  rec- 
reation, and  more  of  joyous  and  health-giving 
work. 


VII 

THE    ALCOHOL    QUESTION 

THE  alcohol  question  has  been  ap- 
proached and  discussed  on  nearly  all 
of  its  sides.  Ancient  and  ignorant  peo- 
ple used  alcohol  because  they  liked  the  ef- 
fect of  it,  and  did  not  bother  to  discuss  it. 
Later  it  was  used  in  religious  rites,  and  for 
some  two  thousand  years  it  has  always  had  de- 
fenders who  took  the  ground  that  the  Creator 
would  not  have  made  it  and  given  His  children 
an  appetite  for  it  unless  it  were  good. 

Then  came  the  awakening.  It  was  observed 
that  no  agent  was  contributing  so  much  to  the 
increase  of  poverty,  crime,  and  destitution  as 
alcohol.  It  was  the  agent  that  was  filling  the 
almshouses  and  prisons.  Statistics  were  com- 
piled, and  the  evidence  against  alcohol  was  in- 
controvertible. In  the  meantime  the  great  tem- 
perance movement  sprang  up.  No  crusade  ever 
had  greater  righteousness  behind  it  or  more 
earnest  men  and  women  enlisted  in  its  cause. 

55 


MEDICAL   SOCIOLOGY 

The  facts  which  they  had  at  hand,  together  with 
the  earnestness  of  the  advocates,  were  sufficient 
to  overwhelm  every  opposition.  Still  the  re- 
sults which  this  great  movement  has  secured, 
compared  with  what  it  has  merited,  have  been 
but  paltry.  Two  reasons  have  contributed  to 
this  failure.  The  first  is  that  the  temperance 
advocates  quite  invariably  "  slopped  over." 
They  were  not  satisfied  with  the  simple  truth 
alone.  It  was  all  they  needed,  and  it  was  more 
than  sufficient  to  prove  their  case.  But  still 
they  have  ever  indulged  in  exaggerations  and 
misstatements.  I  rarely  have  heard  an  hon- 
est man  advocate  the  cause  of  temperance  from 
the  rostrum.  His  argument  usually  has  pre- 
sented the  great  fundamental  truths  of  his 
cause,  and  then  interspersed  them  with  so  much 
that  was  false  that,  to  the  eyes  of  the  discern- 
ing, the  whole  was  but  a  pretty  piece  of  dra- 
matic acting.  Thus  the  great  cause  of  temper- 
ance has  been  sacrificed  to  oratory,  and  to 
the  unfortunate  practice  of  not  treating  one's 
auditors  honestly  and  regarding  them  as  intel- 
ligent beings  to  whom  the  truth,  and  that  alone, 
may  be  told.  This  dishonesty  has  been  carried 
further  than  the  rostrum.  The  innocent  and 
undisceming  child,  who  above  all  should  have 

56 


THE    SOCIOLOGY    OF   HEALTH 

its  credulity  met  with  honesty  and  truth,  has 
been  made  the  dupe  of  these  practices.  They 
have  been  responsible  for  having  written  into 
text-books  on  physiology,  which  were  intro- 
duced into  the  public  schools,  a  chapter  on  the 
effects  of  alcohol  so  grossly  absurd  as  to  be 
a  travesty.  The  cause  of  temperance  has  been 
damaged  by  such  methods.  The  truth  is  suffi- 
cient. The  more  recent  text-books,  through  the 
influence  of  the  Women's  Christian  Temperance 
Union — an  organization  which  has  done  great 
good  in  furthering  the  propaganda  against  al- 
coholism— have  corrected  these  early  errors, 
and  we  now  have  many  fair  and  truthful  expo- 
sitions of  the  effects  of  alcohol. 

The  second  reason  why  the  cause  of  temper- 
ance has  not  prospered  better  is  because  of  the 
innate  liking  on  the  part  of  a  large  portion  of 
the  population  for  the  effects  of  alcoholic  bev- 
erages. The  debauchee  who  has  been  reformed 
by  hysterical  demonstrations  is  not  prone  to 
stay  reformed.  He  has  the  constitutional  crav- 
ing, and  I  doubt  if  our  statistics  on  the  subject 
of  reformations  are  worth  very  much. 

But  alcoholism  is  not  altogether  an  unmiti- 
gated evil.  It  is  an  evidence  of  a  somatic  weak- 
ness or  degeneracy.    The  normal  individual  de- 

57 


MEDICAL    SOCIOLOGY 

stroys  himself  neither  with  alcohol,  tobacco, 
or  sexual  excesses.  The  confirmed  drunkard 
serves  humanity  by  destroying  his  virility  to 
such  a  degree  that  he  does  not  propagate  his 
kind,  and  if  alcohol  is  the  agent  to  shunt  off 
the  degenerate's  line  of  genealogical  progres- 
sion into  the  cul-de-sac  of  oblivion  I  am  not  sure 
but  that  it  has  served  the  human  race  a  good 
turn.  On  the  other  hand  it  is  always  possible 
that  the  touch  of  instability  which  leads  to 
drunkenness  may,  through  the  agency  of  a  nor- 
mal mating,  propagate  offspring  through  whom 
the  paternal  weakness  may  be  made  to  disap- 
pear. Happily,  this  is  often  the  case;  and  it  is, 
indeed,  better  that  a  man  should  be  in  a  line  of 
progressive  improvement  than  in  the  line  of  a 
decadent  family.  It  is  a  bad  sign  when  a  man 
given  to  alcoholic  excesses  boasts  that  his 
father  was  a  moderate  drinker,  and  that  his 
grandfather  drank  not  at  all.  It  augurs  bet- 
ter for  the  family  when  a  man  can  say  that  his 
grandfather  often  drank  too  much,  that  his 
father  was  a  moderate  drinker,  that  he  drinks 
but  rarely,  and  hopes  his  sons  will  not  drink 
at  all. 

It  may  with  some  justice  be  said  that  no  na- 
tion becomes  thoroughly  sober  until  it  has  been 

58 


THE    SOCIOLOGY   OP   HEALTH 

thoroughly  drunk,  that  alcohol  alone  insures  an 
immunity  against  alcoholism;  and  the  ravages 
of  alcohol  among  nations  which  have  never 
before  had  it,  as  our  American  Indians,  and 
the  absence  of  drimkenness  among  the  South 
European  countries  which  long  ago  have  passed 
through  the  stage  of  intoxication,  may  be 
pointed  to  as  proofs  of  this  proposition.  Our 
knowledge  of  the  principles  of  evolution  and  of 
immunity  teaches  us  that  there  is  much  truth  in 
this ;  but  is  it  best  to  secure  immunity  through 
this  channel?  The  answer  is  no.  This  may  be 
further  illustrated.  Let  syphilis  strike  a  peo- 
ple whose  ancestry  is  free  from  syphilis,  and  its 
ravages  are  most  horrible.  The  nations  which 
suffer  the  least  from  syphilis  are  the  nations 
which  have  been  most  thoroughly  syphilized. 
Yet,  what  people  would  invite  syphilis  to  be- 
stow upon  them  such  immunity?  No  longer  do 
we  go  on  the  assumption  that  children  must 
have  the  exanthematous  diseases;  we  try  to 
protect  them  from  them.  It  is  an  immunity 
bought  at  too  dear  a  price. 

This  question  of  alcohol  and  alcoholism  has 
passed  through  all  of  these  phases  of  discus- 
sion, and  finally  it  has  come  to  the  last  stage; 
science  and  common  sense  have  taken  hold  of  it, 

59 


MEDICAL    SOCIOLOGY 

and  here  the  curse  of  rum  is  to  meet  its  defeat. 
During  the  last  ten  years  patient  and  honest 
men  seeking  after  the  truth  have  investigated 
with  scientific  accuracy  the  effects  of  alcohol 
upon  the  animal  organism.  A  large  amount  of 
data  has  been  compiled.  Many  old  theories 
have  been  disproven;  many  have  been  con- 
firmed. But  we  now  have  the  effects  of  alcohol 
upon  a  scientific  basis.  Its  effects  upon  the  vi- 
tal resistance,  upon  the  phagocytic  power  of 
leucocytes,  upon  heat  production,  digestion, 
the  heart's  action,  blood  pressure,  and  upon  the 
nerve  centers,  have  all  been  carefully  studied 
by  many  observers,  who  have  arrived  at  prac- 
tically the  same  conclusions. 

Alcohol  is  a  poison  and  an  irritant,  although 
capable  of  combustion  to  a  certain  degree.  But 
this  does  not  make  it  a  food;  most  of  the  poi- 
sons are  capable  of  combustion  in  the  body; 
they  are  disintegrated,  assimilated,  and  oxi- 
dized. Its  usefulness  in  the  internal  treatment 
of  diseases  is  very  limited.  As  an  antiseptic  its 
value  is  but  small.  When  taken  into  the  nor- 
mal human  body  its  effect  is  harmful,  causing 
a  decrease  of  both  muscular  and  mental  effi- 
ciency in  direct  ratio  to  the  amount  ingested. 
To  say  that  alcohol  gives  a  man  courage  to  face 

60 


THE    SOCIOLOGY   OF   HEALTH 

dangers  is  as  inconsistent  as  to  say  that  mor- 
phine gives  him  courage  to  face  pain.  Alcohol 
paralyzes  the  centers  of  volition  and  the  other 
higher  attributes;  but  first,  and  for  a  brief 
period,  it  stimulates  before  it  paralyzes.  Its 
reputation  for  giving  strength  and  courage  be- 
longs to  this  short  initial  stage. 

Medicine  has  learned  much  of  alcohol  in  re- 
cent years,  but  has  not  given  the  public  the 
benefit  of  the  knowledge.  Physicians  have 
steadily  diminished  the  amount  of  alcohol  used 
in  the  hospitals  until  it  has  become  almost  o1)- 
solete  as  an  internal  remedy,  but  still  the  pub- 
lic has  continued  to  judge  the  medical  profes- 
sion's attitude  toward  alcohol  by  the  copious 
prescribing  of  it  in  the  past  and  by  what  it  sees 
of  the  doctor's  habits  at  his  club  and  at  the  ban- 
quet table.  So  far  as  the  public  knows  alcohol 
is  still  approved  by  the  medical  profession.  It 
is  time  to  set  the  public  straight  in  this  matter, 
and  if  we  have  not  agreed  to  cast  it  out  en- 
tirely much  good  would  come  if  the  public  could 
know  that  it  is  now  but  comparatively  little 
used  as  a  medicine.  The  practical  layman  will 
understand  the  meaning  of  the  fact  when  we 
tell  him  that  in  the  last  twenty-five  years  the 
medical  use  of  alcohol  has  decreased  more  than 

61 


MEDICAL    SOCIOLOGY 

seventy-five  per  cent.  A  remedy  which  is 
being  eliminated  at  this  rate  is  approaching  its 
end. 

If  there  is  any  etiological  relationship  with 
the  certainty  of  which  we  are  familiar,  it  is  that 
between  alcoholism  and  epilepsy.  We  have  as 
good  evidence  of  this  as  we  have  of  the  causa- 
tive relation  subsisting  between  the  bacillus  ty- 
phosus and  typhoid  fever.  The  epilepsy  of 
alcoholism  presents  itself  in  many  phases.  The 
drinker  himself  becomes  an  epileptic,  but  the 
most  important  consideration  is  the  relation  of 
drinking  on  the  part  of  the  parent  to  epilepsy 
in  the  child.  The  epileptic  colonies  are  wit- 
nesses to  the  saying  of  Euripides,  that  "  the 
gods  visit  the  sins  of  the  fathers  upon  the  chil- 
dren." All  observers  of  epilepsy  report  upon 
alcoholism  as  a  prominent  cause  of  this  dis- 
ease, but  there  is  a  large  class  of  cases  which, 
according  to  our  biological  theories,  would 
seem  almost  outside  of  the  influence  of  hered- 
ity. These  cases  are  so  commonly  observed 
that  they  represent  a  distinct  and  important 
contribution  to  the  study  of  heredity.  They 
are  the  occurrence  of  epilepsy  in  offspring 
conceived  while  a  parent  was  under  the  tem- 
porary  influence   of    alcohol,    while   offspring 

62 


THE    SOCIOLOGY    OF    HEALTH 

born  before  and  after  which  were  conceived 
while  the  parent  was  not  using  alcohol  were 
free  from  the  disease.  The  histories  of  epi- 
leptics show  many  cases  which  can  be  traced 
to  single  instances  of  transgression  in  the  use  of 
intoxicants.  Matthew  Woods  reports  the  case 
of  a  yonng  imbecile  girl  who  was  conceived  at 
a  time  when  the  father  was  under  the  influence 
of  alcohol;  four  children  bom  before  this 
period  and  two  bom  subsequent  to  it  being  per- 
fectly well.  In  Caucasus,  where  wine  is  very 
cheap  and  much  used  instead  of  water  to  quench 
thirst,  the  proportion  of  epileptics  is  unusually 
large.  Bourneville,  of  France,  observed  2,554 
children  who  were  admitted  to  the  Bicetre  and 
Fontain  Vallee,  2,072  boys  and  482  girls,  all 
suffering  with  idiocy,  imbecility,  epilepsy,  and 
other  neuroses.  He  found  that  1,053  of  them 
were  the  offspring  of  drunken  parents.  Some 
of  these  cases  are  striking  commentaries  upon 
the  law  of  compensation — industry  and  the  fru- 
gal life  yielding  healthy  offspring  and  opu- 
lence yielding  epileptics.  Woods  refers  to  the 
case  of  a  man  who  scarcely  knew  the  taste  of 
liquor,  and  who  became  the  father  of  four 
healthy  children.  Then  he  became  prosperous 
and  famous,  organized  a  wine  cellar  and  be- 
«  63 


MEDICAL    SOCIOLOGY 

came  a  hon  vivant.  Two  more  cliildren  were 
bom,  both  of  whom  developed  epilepsy. 

While  medical  men  are  familiar  with  this 
etiological  relationshiiD  the  public  is  not;  and 
it  behooves  medicine  to  exert  every  influence 
that  the  public  shall  understand  this  much  of 
the  etiology  of  epilepsy,  and  know  that  so 
much  of  it  at  least  is  not  an  undiscovered 
mystery. 

Another  important  social  relationship  of  al- 
cohol is  that  of  sexual  immorality  and  the  ve- 
nereal diseases.  By  paralyzing  the  higher 
moral  centers  and  irritating  the  sexual  centers 
it  becomes  a  most  potent  agent  for  sexual 
harm.    Alcohol  and  sexual  vice  go  together. 

The  fact  that  in  some  of  our  American  col- 
leges the  students  are  encouraged  in  the  use  of 
beer  and  the  conviviality  which  it  engenders 
can  only  be  taken  as  an  evidence  of  the  be- 
nighted state  of  the  education  in  these  institu- 
tions. The  idea  was  to  emulate  the  practices  of 
the  German  universities,  forgetful  of  the  fact 
that  the  latter  educate  for  special  work  men 
whose  habits  are  formed,  while  our  colleges  are 
endeavoring  to  train  immature  youth  in  the 
rudiments  of  education  with  which  the  German 
university  student  has  long  since  finished.    For 

64 


THE    SOCIOLOGY    OF   HEALTH 

an  educational  institution  to  encourage  youth 
in  the  use  of  alcoholic  drinks,  or  even  to  coun- 
tenance their  use  without  protest,  is  to  commit 
a  sin. 

A  matter  upon  which  the  public  needs  infor- 
mation is  concerning  the  effects  of  alcohol 
drinking  upon  the  upper  air  passages.  It  has 
long  been  believed  that  alcohol  is  a  stimulant, 
and  that  in  moderation  (if  there  is  such  a 
thing)  its  harmful  effect  upon  the  mucous  mem- 
branes is  confined  to  the  abdominal  organs. 
Recent  studies,  showing  that  alcohol  is  locally 
corrosive  and  generally  narcotic,  seem  to  be 
well  founded,  but  that  the  effects  of  alcohol 
goes  further  than  this  and  influences  mucous 
membranes  remote  from  its  place  of  absorption 
has  attracted  but  little  attention. 

Students  of  this  subject  say  that  it  is  excep- 
tional to  find  persons  who  use  spirits  that  do 
not  suffer  from  catarrh  and  subacute  inflam- 
mations of  the  throat  and  nose.  They  report 
that  the  paralysis  of  the  capillaries  caused  by 
repeated  doses  of  alcohol  becomes  a  permanent 
condition,  and  find  this  especially  in  the  respir- 
atory mucous  membranes.  We  are  familiar 
with  the  dilated  capillaries  of  the  spirit  drink- 
er's face.    This  is  a  duplication  of  what  takes 

65 


MEDICAL   SOCIOLOGY 

place  also  in  the  mucous  membrane  of  the  nose 
and  throat. 

The  voices  of  singers  are  very  sensitive  to 
alcohol.  The  changed  tone  of  voice  in  drink- 
ers indicates  thickening  and  changes  in  the 
vocal  cords.  Both  the  bronchial  and  nasal 
tones  are  pronounced  in  chronic  cases,  and  the 
carrying  property  of  the  voice  is  lowered. 
The  laryngologists  assert  that  it  is  compara- 
tively easy  to  cure  bronchial  and  nasal  in- 
flammatory conditions  in  persons  who  abandon 
all  use  of  alcohol  or  narcotics,  but  unless  this  is 
done  the  disease  will  continue  almost  indef- 
initely. It  is  also  shown  that  alcohol  is  a  large 
factor  in  the  production  of  grip  and  chronic 
catarrhs  of  the  throat  by  deranging  the  capil- 
lary circulation  and  interfering  with  the  vital- 
ity of  the  nerve  cells.  Alcohol  is  a  prominent 
etiologic  factor  in  pulmonary  tuberculosis.  But 
of  the  two  evils,  alcohol  is  a  greater  national 
curse  than  tuberculosis. 

The  treatment  of  chronic  alcoholic  inebriety 
should  receive  more  scientific  consideration 
from  the  medical  profession  and  sociologists. 
The  treatment  of  poisoning  with  ptomaines 
and  drugs  is  well  in  hand,  but  the  treatment  of 
alcohol  poisoning  and  addiction  still  receives 

66 


THE    SOCIOLOGY   OF   HEALTH 

most  of  its  attention  from  the  mercenary  ex- 
ploiters of  "  cures."  As  the  insane  were,  until 
recently,  regarded  as  outside  of  the  pale  of 
medical  attention,  so  now  is  the  unfortunate 
alcoholic.  Still  it  is  one  of  the  commonest  dis- 
eases, and  except  among  the  most  enlightened 
the  victim  is  regarded  as  being  possessed  of  a 
vice  just  as  the  insane  man  was  once  regarded 
as  possessed  of  a  devil.  If  a  man  is  found  on 
the  street  suffering  with  opium  poisoning  he  is 
conveyed  to  the  hospital  and  receives  scientific 
and  humane  treatment.  If  a  man  is  found  in 
the  same  place  suffering  with  alcoholic  poison- 
ing he  is  taken  in  charge  by  the  police,  his  am- 
bulance is  a  patrol  wagon,  his  hospital  bed  is  the 
floor  of  a  cell  at  the  police  station  upon  which 
he  is  tossed,  and  in  the  morning  he  appears  be- 
fore a  judge  and  is  fined  for  committing  a  crime. 
Alcohol  poisoning  is  a  bad  thing  in  the  eye  of 
the  law ;  all  other  poisons  are  misfortunes. 

Let  us  put  away  the  mistakes  of  the  past 
and  place  ourselves  in  the  attitude  toward  alco- 
hol which  we  should  have  were  it  a  newly  dis- 
covered chemical  compound  and  had  not  been 
used  by  man  since  history  began.  Having 
learned  its  effect  upon  the  body  we  should  label 
it  "  poison,"  the  same  as  the  other  drugs  of  this 

67 


MEDICAL    SOCIOLOGY 

class,  and  instead  of  being  sold  by  vicious  men 
who  offer  enticements  for  its  consumption  it 
would  be  secured  only  upon  a  physician's  pre- 
scription. 

The  people  look  to  the  medical  profession  for 
instruction  and  guidance  in  matters  of  health. 
The  time  has  come  when  we  should  take  a  posi- 
tive stand  on  this  question.  We  know  the  large 
harm  that  alcoholic  beverages  are  inflicting 
upon  the  people.  Its  ravages  are  known  as  well 
as  those  of  typhoid.  We  know  them  so  well 
that  we  scarcely  need  discuss  them  among  our- 
selves. We  know  how  much  weaker  the  resist- 
ance to  disease  is  on  the  part  of  the  man  who 
has  habitually  taken  alcohol  than  it  is  in  the 
man  who  has  not.  We  know  the  frightful  mor- 
tality in  pneumonia  and  Bright's  disease  among 
drinking  men.  We  know  the  frequency  and 
dangers  of  delirium  tremens  occurring,  as  it 
often  does,  in  men  who  have  drunk  daily  but 
never  in  amounts  to  produce  intoxication.  We 
know  the  difficulties  experienced  by  the  drink- 
ing man  when  he  requires  a  surgical  operation. 
It  devolves  upon  us  to  instruct  the  public  as 
to  the  dangers  of  alcohol  just  as  it  does  to  in- 
struct them  concerning  the  dangers  of  polluted 
water  or  bad  milk.    Alcohol  is  not  a  food.    It 

68 


THE    SOCIOLOGY    OF   HEALTH 

causes  one  tenth  of  the  deaths  in  the  United 
States;  yet  the  people  spend  over  two  billion 
dollars  yearly  for  this  poison. 

We  should  have  in  this  country  societies  ^ 
under  medical  influence  to  promote  the  study 
of  alcohol  and  alcoholism,  to  disseminate  infor- 
mation on  the  subject,  and  to  use  their  influence 
in  furthering  the  cause  of  temperance.  This 
is  distinctly  the  province  of  medicine.  The 
medical  profession,  more  than  any  other  class, 
could  have  the  greatest  influence  for  good  in 
social  and  professional  life,  and  no  other  class 
can  be  looked  to  for  information  so  reliable. 
The  time  is  ripe  for  a  great  and  sane  temper- 
ance movement,  conducted  by  this  profession, 
telling  the  public  simply  the  truth  about  alcohol 
as  we  have  told  it  about  tuberculosis,  dissem- 
inating knowledge  and  the  incontrovertible 
facts.  The  value  of  such  a  movement  to  this 
country  is  beyond  the  power  of  the  most  hope- 
ful to  foresee. 

» Germany  has  become  sufficiently  aroused  in  this  matter  to 
have  a  Society  of  Physicians  for  the  Promotion  of  Total  Absti- 
nence, which  is  doing  a  splendid  work.  It  issues  a  Korrespon- 
denz-Blatt,  and  its  influence  is  making  a  positive  impression  upon 
the  medical  profession  and  the  public.  The  American  Society 
for  the  Study  of  Alcohol  and  other  Drug  Narcotics  is  a  similar 
organization,  and  promises  to  be  of  great  service. 

69 


vni 

THE   VENEREAL   PERIL 

THERE  are  many  conditions  threatening 
society  which  because  of  their  noxious- 
ness and  tendency  to  spread  are  prop- 
erly designated  as  perils.  Some  of  these  seem 
inevitable,  the  remedies  for  their  eradication 
not  having  yet  been  evolved.  Others  are  dis- 
tinctly remediable,  all  of  the  essentials  for  Ijheir 
removal  being  at  hand.  Given  a  great  social 
evil,  recognized  by  society  as  an  evil,  the  rec- 
ognition backed  by  a  desire  to  be  rid  of  it,  so- 
ciety will  destroy  it  when  two  conditions  are 
attained.  These  conditions  are:  first,  a  scien- 
tific recognition  of  its  nature,  and,  second,  a 
general  education  of  the  public  as  to  its  signifi- 
cance. One  of  the  greatest  of  social  evils  ex- 
ists because  only  the  first  of  these  conditions 
has  been  attained.  Its  nature  and  harm  are  un- 
derstood by  a  few,  but  the  great  mass  of  society 
gropes  in  ignorance.  The  ignorance  of  sexual 
life  and  sexual  hygiene,  added  to  the  sexual  in- 

70 


THE    SOCIOLOGY   OF   HEALTH 

stinct,  results  in  a  combination  productive  of  as 
great  evil  as  any  scourge  that  has  afflicted  man- 
kind. Because  of  these  society  harbors  a  plague 
of  disease  and  a  pestilence  of  immorality  which 
is  emasculating  the  strong,  destroying  homes, 
weakening  the  foundations  of  society,  filling 
our  hospitals  and  asylums  with  wrecks  of  hu- 
man beings,  spreading  disease  into  the  sources 
of  life,  and  deteriorating  the  race.  This  is  the 
venereal  peril,  and  it  behooves  us  to  cast  aside 
prudishness  and,  with  frankness  and  clear  vi- 
sion, see  what  it  means. 

The  two  great  venereal  diseases  are  gonor- 
rhea and  syphilis.  In  this  country  our  statis- 
tics are  incomplete,  but  in  Europe  seventy-five 
per  cent  of  adult  males  have  had  gonorrhea, 
and  twelve  and  a  half  per  cent  of  adult  males 
have  had  syphilis.  In  the  United  States  it  is 
calculated  that  sixty-five  per  cent  of  adult  males 
have  had  gonorrhea.  It  is  the  most  prevalent 
of  all  diseases  next  to  measles.  In  this  country 
800,000  males  reach  maturity  annually.  Of  this 
number  500,000  become  infected  with  the  latter 
disease.  It  is  stated  by  Morrow  ^  that  twenty 
per   cent  become  infected  before   the   age   of 

'Transactions  Society  of  Sanitary  and  Moral  Prophylaxis, 
1906. 

71 


MEDICAL    SOCIOLOGY 

twenty-one  years,  sixty  per  cent  before  the  age 
of  twenty-five  and  eighty  per  cent  before  the 
age  of  thirty.  There  are  14,000,000  male  adults 
under  the  age  of  thirty  in  the  United  States, 
and  the  most  reliable  observers  calculate  that 
8,000,000  of  them  have  gonorrhea  or  its  sequelse. 
The  trail  of  physical  suffering  which  follows  in 
the  wake  of  these  appalling  figures  is  insignifi- 
cant when  compared  with  the  mental  anguish, 
the  broken  hearts,  and  the  saddened  homes  that 
mark  their  path.  The  woman  who  cohabits 
with  a  gonorrheic  is  doomed  to  infection,  and 
that  such  infection  is  the  lot  of  a  vast  and  grow- 
ing army  of  American  women  is  attested  by  the 
multiplication  of  gynecologists  and  of  hospitals 
for  the  relief  of  these  unfortunates.  Let  the 
layman  not  think  of  this  as  a  disease  of  the 
vicious.  Gonorrhea  is  a  disease  of  the  virtuous 
wives  in  our  great  cities  as  well  as  of  the  prosti- 
tutes. We  have  no  statistics  at  hand  upon  the 
prevalence  of  this  condition,  but  the  busiest 
specialty  of  medicine  and  surgery  is  that  which 
deals  with  these  diseases.  Gynecologists  re- 
port that  more  than  seventy-five  per  cent  of 
the  operations  required  for  inflammatory  dis- 
eases in  women  is  due  to  gonorrhea.  The  ma- 
jority of  abdominal  operations  upon  women  are 

72 


THE    SOCIOLOGY    OF    HEALTH 

for  this  cause.  This  does  not  take  into  consid- 
eration the  large  number  of  women  who  are  not 
operated  upon  but  who  drag  out  a  miserable 
existence. 

Gonorrheal  infection  is  acquired  by  the  in- 
nocent wife  from  her  husband.  In  his  bach- 
elor days  he  got  it  from  an  infected  woman. 
He  thought  he  was  cured,  but  there  were  gon- 
ococci  living  still  in  the  deep  parts  of  his  urethra 
which  were  awakened  to  activity  by  the  renewal 
of  sexual  life.  Unhappily,  this  disease  makes 
little  or  no  impression  on  a  man's  general 
health,  and  he  thinks  of  it  lightly,  while  but  few 
diseases  afflict  women  that  are  fraught  with 
greater  chronicity  and  more  permanent  harm. 
The  reawakening  of  his  old  disease  and  the  ap- 
pearance of  the  same  thing  in  his  bride  has 
prompted  many  a  man  to  accuse  an  innocent 
woman  of  having  been  the  original  purveyor  of 
the  malady.  A  man  who  has  once  had  gonor- 
rhea is  a  dangerous  man  to  marry,  and  sixty- 
five  to  seventy-five  per  cent  of  the  women  who 
wed  are  accepting  this  danger. 

These  statements  are  not  matters  of  surmise ; 
our  knowledge  of  this  condition  is  woefully 
complete.  It  can  be  recognized  with  certainty. 
The  gonococcus,  the  cause  of  the  disease,  is  one 

73 


MEDICAL    SOCIOLOGY 

of  the  most  easily  identified  microorganisms, 
and  there  is  no  disease  with  which  the  gyne- 
cologists are  more  familiar. 

Childless  marriages  were  once  thought  to  be 
due  to  certain  incompatibilities,  visitations  of 
Providence,  and  inherent  defects  on  the  part  of 
the  wife.  The  wife  was  once  regarded  as  guilty 
in  the  sight  of  the  law  if  she  bore  her  spouse 
no  children,  and  could  be  cast  aside  for  steril- 
ity. Scientific  knowledge  has  thrown  light  upon 
this  dark  place  in  the  progress  of  women's 
emancipation,  and  the  culpability  is  now  placed 
where  it  belongs.  Gonorrhea  is  responsible  for 
most  of  the  sterility  in  childless  marriages 
(seventy-five  per  cent  is  a  conservative  figure). 
Pretty  full  statistics  are  to  be  had  upon  this 
subject.  Unfruitfulness  in  thirty  per  cent  of 
marriages  is  due  to  sterility  of  the  male,  caused 
by  gonorrhea  having  involved  the  spermatic 
duct  and  the  epididymis.  Active  disease  in 
these  cases  may  have  subsided,  the  male  not 
conveying  infection,  delivering  to  the  female 
neither  gonococci  nor  spermatozoa,  but  being 
apparently  potent  and  healthy.  Forty-five  per 
cent  of  the  unfruitfulness  in  marriages  are  due 
to  gonorrhea  in  the  woman  acquired  from  the 
man.    The  infection,  once  implanted,  progresses 

74 


THE    SOCIOLOGY   OF   HEALTH 

upward  into  the  uterus  and  thence  through  the 
Fallopian  tubes  to  the  ovaries.  It  is  the  married 
woman's  most  common  disease.  Every  prosti- 
tute has  it  and,  fortunately  for  society,  it  ren- 
ders her  sterile.  It  is  the  bond  of  sympathy 
between  these  two  great  classes  of  women  sup- 
plied by  the  husbands.  It  exists  in  every  de- 
gree of  severity.  In  some  it  produces  scarcely 
a  symptom,  often  not  reaching  the  tubes  until 
after  the  first  and  only  child  has  been  bom,  and 
then  sealing  them  up  against  the  passage  of 
further  ova  and  producing  what  the  German's 
have  designated  as  "  one-child  sterility."  In 
others  the  fulminating  signs  are  present :  acute 
inflammation  of  the  tubes  and  ovaries,  abscess- 
es, peritonitis.  Between  these  lie  all  degrees 
of  pelvic  ills,  acute  and  chronic.  But  ultimately 
the  tubes  are  sealed  and  sterility  supervenes. 
This  condition  is  the  most  prolific  cause  of  ex- 
tra-uterine pregnancy.  Seventy-three  per  cent 
of  spontaneous  abortions  in  the  United  States 
are  due  to  endometritis  which  is  usually  due  to 
gonorrhea.  The  large  proportion  of  sterile 
marriages  and  of  abortions  is  not  a  matter  of 
choice,  as  is  commonly  believed,  but  is  due  to 
disease. 
There  are  110,000  blind  persons  in  the  United 
75 


MEDICAL    SOCIOLOGY 

States.  A  large  part  of  this  blindness  is  the 
result  of  venereal  disease.  More  than  eighty 
per  cent  of  the  cases  of  blindness  of  the  new 
born  are  due  to  gonorrhea,  infecting  the  eyes 
of  the  child  during  the  moments  of  its  birth. 
While  this  eye  disease  is  easily  amenable  to 
treatment  still  twenty  per  cent  of  all  blindness 
at  present  in  the  asylums  of  New  York  State  is 
due  to  that  cause  alone.  Syphilis  also  furnishes 
its  quota. 

Another  venereal  scourge  of  childhood  is 
gonorrheal  vulvovaginitis — a  disease  of  horri- 
ble prevalence.  The  little  girl  in  the  clean 
house  contracts  it  from  the  hands  of  the  gonor- 
rheal nurse  who  gives  her  her  bath.  In  institu- 
tions, asylums,  and  orphanages,  it  breaks  out 
and  passes  from  child  to  child,  being  transmit- 
ted by  clothing,  towels,  and  the  bath,  until  it 
assumes  the  character  of  an  epidemic.  Its  con- 
sequences for  later  life  are  serious,  and  its 
chronicity  is  much  to  be  dreaded.  Slow  and 
insidious,  often  scarcely  affecting  the  general 
health  of  the  little  girl,  the  infection  finds  its 
way  to  the  uterus,  tubes,  and  ovaries  producing 
conditions  which  result  in  sterility  in  later  life, 
and  often  causing  developmental  defects  in 
these  organs  and  retardation  of  their  growth. 

76 


THE    SOCIOLOGY    OF    HEALTH 

In  our  great  cities  acute  gonorrhea  in  little 
girls,  contracted  by  actual  sexual  contact  with 
the  male,  is  by  no  means  an  uncommon  con- 
dition. 

Concerning  syphilis,  Pinard,  in  a  study  of 
10,000  consecutive  cases  of  miscarriage  in  Eu- 
rope, found  forty-two  per  cent  of  them  associ- 
ated with  this  disease.  Hereditary  syphilis 
claims  a  mortality  of  from  sixty  to  eighty-six 
per  cent.  It  is  one  of  the  most  fatal  of  diseases 
among  the  new-born.  The  most  reliable  statis- 
tics to  be  found  in  connection  with  this  condi- 
tion are  in  France,  where  20,000  children  die 
yearly  of  syphilis,  and  where  the  total  mor- 
tality from  that  disease  is  seven  and  a  half 
per  cent.  This  is  not  because  the  disease  is 
more  prevalent  in  that  country,  but  because 
the  statistics  are  more  carefully  compiled.  It 
is  quite  as  prevalent  in  England,  and  in  Eus- 
sia  it  is  so  common  that  whole  villages  are  in- 
fected, with  but  few  individuals  who  are  not 
syphilitic.  In  Zanzibar  five  sixths  of  the  na- 
tives are  syphilitic.  On  the  Gold  Coast  thirty 
per  cent  of  the  population  has  this  disease.  It 
was  carried  to  these  places  by  the  onward 
march  of  what  is  called  civilization.  Cook's 
crew  took   syphilis  to   the   Sandwich  Islands, 

77 


MEDICAL    SOCIOLOGY 

where  it  soon  became  epidemic.  Civilization 
and  syphilization :  Arcades  ambo!  Syphilis  is 
the  great  cause  of  the  destructive  diseases  of 
the  nervous  system.  In  its  inherited  form  it 
is  the  greatest  cause  of  epilepsy.  The  pro- 
gressive paralysis  of  childhood  is  one  of  the 
results  of  hereditary  syphilis.  It  is  the  most 
prevalent  cause  of  paresis  and  locomotor 
ataxia.  The  more  thoroughly  the  histories  of 
the  insane  have  been  studied  the  more  has 
syphilis  loomed  up  as  a  causative  factor.  In 
the  United  States  Army  syphilis  causes  the  dis- 
charge of  more  men  for  physical  disability  than 
does  tuberculosis.  Although  it  is  amenable  to 
treatment  still  it  decreases  the  period  of  life 
expectancy  by  one  third.  It  lowers  the  general 
resisting  power  of  the  individual  and  renders 
him  particularly  prone  to  tuberculosis. 

These  diseases  attack  not  only  the  young,  but 
slay  the  child  before  it  is  born.  They  prevent 
conception.  Most  of  the  sterility  of  women  is 
due  to  gonorrhea  contracted  from  the  male. 
Fifty  per  cent  of  gonorrheal  women  are  sterile. 
The  busy  specialists  in  venereal  diseases  give 
us  these  figures  out  of  the  abundance  of  their 
experience.  Morrow  has  said  that  seventy  per 
cent  of  the  women  who  presented  themselves 

78 


THE    SOCIOLOGY   OF   HEALTH 

to  him  for  treatment  for  venereal  diseases  even 
at  the  public  hospitals  were  respectable  mar- 
ried women  who  had  been  infected  by  their  hus- 
bands. In  1901,  in  New  York  City,  162,372 
cases  of  gonorrhea  and  syphilis  were  treated 
in  the  private  practices  of  physicians.  This 
represents  but  a  minority  of  the  cases,  as  the 
majority  are  treated  in  hospitals,  in  drug  stores, 
in  the  offices  of  the  advertising  quacks,  and  a 
large  proportion  are  not  treated  at  all. 

We  must  beware  of  distinctions  between 
the  guilty  and  the  innocent.  If  there  is  such  a 
thing  as  guilt  and  innocence  the  guilt  lies  with 
parents  and  teachers  and  with  the  state.  Bulk- 
ley  has  published  a  book  entitled  "  Syphilis  of 
the  Innocent,"  in  which  he  reports  some  3,000 
cases  of  this  disease  contracted  by  agencies  ex- 
ternal to  venereal  congress.  It  is  a  scientific 
recountal  of  appalling  sadness,  describing  in- 
fection from  the  drinking  cup,  the  public  towel, 
the  barber's  razor,  the  kiss  bestowed  upon  the 
helpless  child,  and  through  a  hundred  other 
avenues  of  infection. 

The  prevalence  of  these  conditions  is  one  of 

the  darkest  blots  upon  our  civilization.     The 

physician  knows  their  horror ;  his  services,  alas, 

are  sought  when  the  damage  has  been  done. 

7  79 


MEDICAL    SOCIOLOGY 

The  tragedy  of  marriage  is  known  to  him.  The 
pomp  and  ceremony,  the  flowers  and  ribbons, 
the  music  and  sweet  odors,  all  too  often  fade 
away  into  the  grim  presence  of  blighted  hopes, 
of  household  joys.  Poor  man  with  the  invalid 
wife !  poor  childless  woman !  We  pity  you  both. 
It  is  not  your  faults ;  you  would  have  lived  and 
loved  in  health  and  happiness  had  parents  and 
teachers  been  true  to  you ! 

There  is  much  in  literature  which  it  behooves 
us  to  recognize  as  prejudicial  to  sexual  moral- 
ity. It  is  not  the  statements  of  the  whole  truth 
which  we  need  object  to  —  there  is  no  naked 
truth  which  need  not  be  told,  provided  all  is 
told,  and  that  in  truthful  perspective.  What 
makes  for  ill  is  the  glorification  of  sexual  crime 
and  the  heroization  of  sexual  criminals.  The 
public  prints  which  exploit  the  doings  of  the 
violator  of  the  marriage  vows,  to  the  neglect 
of  the  noble  deed  of  virtue,  we  know  are  breed- 
ing harm.  The  literature  of  salaciousness  is 
productive  of  decided  damage.  Nor  would  I 
exempt  from  this  category  the  recountals  of 
sexual  sins  as  found  in  the  Bible,  and  the  relig- 
ious glorification  of  men  whose  sexual  lives 
should  be  spoken  of  with  shame.  The  exalting 
of  these  immoral  acts,  by  surrounding  them 

80 


THE    SOCIOLOGY    OF    HEALTH 

with  the  halo  of  reverence,  makes  for  results 
which  are  subversive  of  morality. 

It  is  an  extraordinary  thing  that  the  subject 
of  sexual  morality,  which  is  so  close  to  the  hap- 
piness of  domestic  life,  should  have  been  so 
neglected.  When  Herbert  Spencer  asked  and 
answered  the  question,  "  AMiat  knowledge  is  of 
the  most  worth?  "  he  presented  the  preeminent 
importance  of  a  knowledge  of  the  laws  of  health 
as  the  supreme  safeguard  of  the  happiness  of 
the  individual.  But  tardily  have  educators  pro- 
ceeded to  apply  the  great  principles  which  he 
laid  down.  AYith  studied  care  this  question  of 
sexual  health  has  been  ignored  by  teachers  and, 
sadder  still,  avoided  by  parents  until  finally  the 
child  learns  it,  as  learn  it  he  will,  from  lewd 
companions ;  but  truly  what  he  learns  is  not  sex- 
ual hygiene  but  sexual  immorality.  Let  us  not 
make  the  mistake  of  saying  that  this  is  a  dirty 
subject  and  that  we  cannot  touch  it.  I  have 
heard  this  said  by  those  who,  while  professing 
to  fight  evil,  confined  the  fight  to  nice,  genteel 
evils  which  are  chiefly  matters  of  the  imagina- 
tion and  of  belief.  No,  it  is  a  clean  and  glorious 
thing  to  say  the  word  that  shall  save  a  young 
man  or  woman  from  invalidism  and  moral  dis- 
couragement.   There  are  things  to  be  said  and 

81 


MEDICAL    SOCIOLOGY 

things  to  be  done  which  should  be  said  frankly 
and  done  boldly. 

The  protection  of  the  innocent  demands  that 
the  young  shall  know  the  sexual  biology  of  man 
just  as  he  should  know  of  the  fertilization  and 
blossoming  of  flowers.  The  sexual  instinct  is 
the  most  imjDortant  of  all  the  social  instincts. 
It  is  wrong  and  false  to  degrade  it  by  treating 
it  as  though  it  were  a  shameful  thing.  The 
teaching  of  one  of  the  dominant  modern  relig- 
ions that  sexual  joy  is  carnal  sin  and  that  the 
death  of  the  body  is  the  great  goal  is  not  as 
sound  as  that  of  some  of  its  precursors,  which 
exalted  the  giving  of  life.  The  mental  and 
moral  state  of  "  Western  civilization  "  makes  it 
impossible  for  it  to  interpret  fairly  or  intelli- 
gently the  real  spirit  of  the  old  phallic  sym- 
bolism. But  when  we  come  to  look  at  these 
things  rightly  we  shall  see,  perhaps,  as  much 
virtue  in  the  symbol  of  life  as  in  the  symbol  of 
death.  One  of  the  most  beautiful  gifts  we  have 
received  from  nature's  hand  is  the  love  of  man 
and  woman.  To  say  that  man  is  conceived  in 
sin  is  but  one  of  the  dronings  of  cant. 

Let  us  speak  plainly.  The  best  interests  of 
the  individual,  of  the  home,  and  of  society  de- 
mand that  man  shall  cohabit  with  none  but  his 

82 


THE    SOCIOLOGY   OF   HEALTH 

wife ;  if  a  woman  is  not  his  wife  lie  shall  not  co- 
habit with  her.  This  is  a  simple  rule;  it  will 
stand  the  test  of  analysis,  it  is  easy  to  remem- 
ber, and  it  should  be  taught,  along  with  the 
reasons  for  it,  to  every  boy  and  girl  who  reaches 
puberty. 

Infringement  of  this  rule  makes  for  ill.  The 
penalties  and  dangers  in  its  violation  I  should 
enumerate  as  follows: — They  are:  the  moral 
and  social  degradation  of  a  woman  who  other- 
wise would  live  rightly;  the  danger  of  causing 
disease  in  such  a  woman;  the  encouragement, 
by  example,  of  a  practice  which  stands  preem- 
inent as  the  great  cause  of  social  unhappiness ; 
the  subtraction  of  just  so  much  joy  and  devo- 
tion from  the  woman  who  should  or  will  stand 
in  the  proper  relation  of  wife;  the  possibility 
of  the  propagation  of  illegitimate  children;  the 
strong  probability  of  contracting  venereal  dis- 
ease; the  danger  of  transmitting  physical  or 
moral  blight  to  one's  offspring;  the  develop- 
ment of  vicious  habits;  the  cultivation  of  im- 
moral society;  the  wasting  of  time  and  energy 
in  unprofitable  company;  the  social  harm  to 
oneself  and  family;  the  moral  harm  which 
springs  from  acting  in  secretiveness  and  shame ; 
the  contracting  of  the  concomitant  vices  which 

83 


MEDICAL    SOCIOLOGY 

go  hand  in  hand  with  venery  for  venery's  sake; 
and  the  postponement  of  the  organization,  or 
the  weakening  of  the  strength,  of  the  most  po- 
tent factor  in  the  solidarity  of  society — the 
home.  These  are  strong  reasons  against  extra- 
marital sexual  intercourse,  and  each  is  suscept- 
ible of  serious  consideration.  Moreover,  to 
these  should  be  added  the  fact  that  sexual  inter- 
course is  absolutely  not  necessary  for  one's 
health;  the  suggestion  that  it  is  necessarj''  is 
only  repeated  and  passed  along  by  the  offend- 
ers who  desire  an  excuse  for  their  own  laches, 
or  by  those  who  in  ignorance  repeat  a  tradition. 

It  is  not  so  much  a  want  of  virtue  or  of  mor- 
als that  concerns  us  as  it  is  a  want  of  knowledge 
and  adequate  instruction.  The  only  cure  for 
the  lack  of  virtue  which  will  stand  every  test  is 
Iniowledge.  Evils  which  cannot  be  remedied  by 
the  cleansing  power  of  truth  are  beyond  the 
reach  of  human  agencies.  If  to  know  all  is  to 
forgive  all,  so  also  is  it  true  that  to  know  all  is 
to  escape  the  necessity  for  being  forgiven. 

The  beginning  of  the  victory  over  this  great 
social  scourge  will  come  when  its  real  charac- 
ter is  known  and  understood  by  all  men  and 
women;  when  the  penalties  for  violations  of 
sexual  hygiene  are  as  common  knowledge  as  are 

84 


THE    SOCIOLOGY    OF    HEALTH 

the  penalties  for  violations  of  the  common  law 
of  the  state;  when  the  dangers  of  falls  into 
adultery  are  understood  as  well  as  are  the  dan- 
gers of  physical  falls;  and  when  the  tinsel  is 
struck  from  the  shoulders  of  women  of  loose 
sexual  practices  and  the  pitiable  creature  be- 
neath is  exposed.  There  is  little  distinction 
between  the  innocent  and  the  guilty;  all  who 
suffer  through  unenlightenment  are  innocent, 
for  no  one  is  so  guilty  as  to  elect  rmhappiness. 
At  the  bottom  of  these  troubles  lies  the  igno- 
rance which  it  devolves  upon  society  to  remedy. 
Medical  science  has  accumulated  the  knowledge 
which  is  necessary  to  correct  these  evils; 
it  remains  for  the  parent,  the  teacher,  and  the 
guardian  of  public  morals  to  apply  it. 


IX 


THE   INSTRUCTION    OF    THE   YOUNG   IN    SEXUAL 
HYGIENE 

"Learn  what  is  true  in  order  to  do  what  is  right." — Huxley. 

THERE  are  certain  accompaniments  of 
civilization  which  at  one  time  were  use- 
ful, and  which,  though  no  longer  of  serv- 
ice, still  retain  their  hold  and  influence  by 
virtue  of  traditional  esteem.  There  are  super- 
stitions which  have  been  of  use  to  mankind,  and 
which  we  still  permit  to  linger  and  enjoy  a 
bounty  in  the  presence  of  enlightenment  long 
after  they  should  have  been  dismissed.  Among 
these  relics  of  the  past  there  is  one  ancient  vir- 
tue, lingering  beyond  its  time,  for  the  entertain- 
ment of  which  we  pay  a  mighty  price.  It  is 
prudishness,  and  it  takes  its  pay  in  lives  and 
happiness  and  in  domestic  joys  and  the  virtue 
of  our  children.  In  the  most  important  branch 
of  human  learning,  that  which  means  the  pres- 
ervation of  health  and  physical  efficiency,  prud- 
islmess  raises  its  hand  and  denies  enlighten- 

86 


THE    SOCIOLOGY    OF    HEALTH 

ment  in  that  knowledge  which  is  precious 
beyond  price. 

The  best  preparation  for  moral  and  useful 
living  is  to  be  found  in  knowing  the  truth,  and 
the  most  imjoortant  truths  for  the  individual  to 
know  are  the  truths  concerning  himself.  One 
of  the  errors  of  our  time  is  that  we  take  out 
of  the  book  of  human  knowledge  a  whole  chap- 
ter, write  "  tabooed "  across  it,  and  sequester 
it  from  those  who  need  it  most. 

Let  us  be  honest,  and  let  us  begin  our  honesty 
with  the  child.  It  would  be  a  boon  to  humanity 
if  we  would  be  frank  and  fair  with  children. 
Dissembling  has  wrought  much  ultimate  harm. 
It  is  unfortunate  that  youth  is  willfully  de- 
ceived by  the  parent  who  excuses  himself  with 
the  self-assurance  that  the  child  will  learn  for 
himself  soon  enough  what  is  true.  It  is  not 
alone  in  the  realm  of  the  religious  superstitions 
in  which  men  no  longer  believe,  nor  in  the  little 
sentimental,  domestic,  fairy  tales,  but  it  is  in 
the  questions  of  sex  life  that  the  great  harm  of 
dishonesty  springs. 

We  are  beginning  to  appreciate  the  impor- 
tance of  the  teaching  of  the  natural  sciences. 
The  moral  value  of  such  teaching  is  beginning 
to  be  realized,  but  it  must  be  carried  home  to 

87 


MEDICAL    SOCIOLOGY 

the  individual  to  be  of  the  most  good.  Chil- 
dren should  understand  at  least  as  much  of 
their  own  selves  as  they  do  of  the  starfish  or 
the  buttei'fly.  When  the  father  calls  his  son 
into  the  library,  closes  the  door,  and  with  awful 
formality  announces,  "  My  son,  I  wish  to  talk 
with  you  upon  a  subject  which  is  not  touched 
upon  in  any  of  the  things  which  you  have  as 
yet  studied,"  we  realize  that  the  father  is  ad- 
mirable in  his  intentions,  pitiable  in  his  method, 
and  that  if  the  boy  had  had  the  simple  advan- 
tages which  should  have  been  his  by  right  no 
such  performance  as  this  would  have  been  nec- 
essary. Moreover,  unless  this  library  scene  is 
enacted  early  the  well-meaning  parent  will  have 
little  that  is  new  to  offer;  juvenile  wisdom  will 
have  preceded  him.  The  phenomena  of  nature 
are  so  intimately  associated  with  human  inter- 
ests, every  branch  of  knowledge  overlaps  other 
branches  to  such  a  degree,  that  we  shall  do 
wisely  in  dealing  with  the  child  not  to  wander 
away  from  nature's  intimacies,  but  rather  to 
take  advantage  of  them  in  driving  home  the 
lessons  of  life.  The  biological  principles  which 
underlie  reproduction  among  the  flowers  also 
underlie  reproduction  among  the  lower  animals 
and  man,  and  the  children  should  know  the  sim- 

88 


THE    SOCIOLOGY    OF    HEALTH 

pie  truths  concerning  them.  If  they  are  not 
thus  taught  they  will  learn  to  their  harm  to 
think  of  the  human  sexual  relation  as  some- 
thing peculiar  and  mystic. 

We  use  in  our  language  such  words  as  pudic ' 
and  pudendwn,  from  piidere  (to  be  ashamed), 
of  which  we  might  well  be  ashamed,  for  they 
are  symbols  not  of  virtue,  but  of  lack  of  virtue. 
To  teach  the  child  that  certain  parts  are  vulgar 
and  others  not  is  the  beginning  of  evil.  Accord- 
ing to  the  older  pedagogy  the  liver  is  honorable, 
the  kidneys  dishonorable;  the  organs  of  masti- 
cation genteel,  but  those  of  generation  vulgar. 
We  grow  up  from  childhood  with  these  ideas  so 
strongly  fixed  in  our  minds  that  even  among 
the  thoughtful  and  mature  it  is  almost  a  psy- 
chological impossibility  to  think  with  favor  of 
the  ideal  state  of  mind  which  regards  none  of 
them  as  pudendus — to  be  ashamed  of.  Surely, 
persons  having  children  under  their  care,  in 
the  present  state  of  enlightenment,  need  not 
ride  roughshod  over  the  usages  of  the  times 
— that  would  be  social  unwisdom — ^but  they  can 
refrain  from  prudishness  and  dishonesty,  and 
they  can  approve  of  the  teaching  of  the  natural 
sciences,  and  by  pointing  out  their  relations  to 
human  life  and  morals  they  can  endorse  the 

89 


MEDICAL    SOCIOLOGY 

sanctity  of  the  human  body  and  the  goodness  of 
all  that  is  useful. 

Some  of  the  ancient  civilizations  of  the  East 
have  exemplified  these  things,  and  accordingly 
displayed  a  superior  morality.  When  our  mis- 
sionaries have  reported  them  as  being  vulgar, 
and  striven  to  change  their  ancient  customs,  it 
often  has  been  because  the  missionaries  were 
vulgar  and  not  they.  When  we  have  attained 
to  the  state  of  civilization  which  lies  within  our 
reach  the  pudenda  will  not  be  the  normal  gen- 
erative parts,  but  the  tuberculous  lung,  the  ty- 
phoid intestine,  decayed  teeth,  bunions,  and  idle 
hands — these  are  the  things  of  which  we  shall 
be  ashamed. 

How  and  what  shall  the  youth  be  taught  con- 
cerning the  sexual  questions?  This  is  not  dif- 
ficult to  answer  if  we  put  aside  guile  and  stand 
for  honesty  with  the  child.  Between  four  and 
six  years  of  age  children  are  full  of  curiosity; 
the  world  is  full  of  enigmas,  and  their  minds 
are  reaching  out  for  the  truth.  It  is  not  neces- 
sary to  volunteer  information  to  them,  but  let 
their  questions  be  answered  truthfully.  Boys 
between  eight  and  ten  and  girls  between  eight 
and  twelve  should  be  taught  the  physiology  of 
human  sex.    This  should  be  conducted  by  intel- 

90 


THE    SOCIOLOGY    OF   HEALTH 

ligent  and  discreet  teachers,  preferably  par- 
ents, not  by  class-room  methods,  but  by  in- 
formal, close  personal  talks.  The  best  teacher 
is  an  intelligent  mother.  These  talks  should 
have  been  preceded  by  the  regular  studies  of 
the  natural  sciences.  Children  of  this  age 
should  have  studied  already  the  elements  of 
botany,  zoology,  and  physiology,  the  modes  of 
propagation  and  growth  of  plants  and  the  lower 
animals.  They  should  know  the  meaning  of 
seed,  fertilization,  and  the  sexual  distinctions, 
following  nature  from  the  simple  little  truths 
up  to  the  great  things.  These  are  of  more  im- 
portance to  them  from  a  cultural  and  practical 
standpoint  than  are  grammar,  history,  rhetoric, 
or  algebra.  When  we  come  to  the  sexual  rela- 
tions of  men  and  women  it  is  not  advisable  to 
discuss  the  details  of  sexual  contact.  The  judg- 
ment of  the  teacher  will  tell  how  much  to  teach, 
but  let  naught  be  said  that  is  false  or  mislead- 
ing. If  there  have  been  the  proper  preliminary 
studies  of  the  natural  sciences  the  human  physi- 
ology of  sex  will  unfold  itself  in  a  natural  se- 
quence, and  the  child  will  learn  in  a  dignified 
and  respected  way  what  most  children  are  now 
learning  in  association  with  the  obscene. 
Boys  at  this  age  should  be  taught  the  sacred- 
91 


MEDICAL    SOCIOLOGY 

ness  of  their  person,  the  importance  of  good 
health  and  cleanliness.  They  should  be  in- 
structed in  the  physiological  relations  between 
their  brains  and  sexual  organs,  and  the  impor- 
tance of  pure  thoughts.  Inasmuch  as  practi- 
cally every  boy,  sooner  or  later,  between  eight 
and  fourteen  learns  or  is  taught  to  masturbate, 
the  harmfulness  of  this  practice  should  be  dealt 
with.  Boys  should  be  instructed  not  to  handle 
themselves.  At  fourteen  to  sixteen  the  boy 
should  be  told  more  fully  of  sexual  things.  He 
should  know  his  power  of  fatherhood.  Lest  he 
become  worried  concerning  seminal  emissions 
occurring  during  sleep,  he  should  be  informed 
of  their  possibilities  and  harmlessness.  Unless 
he  is  told  this  he  will  inevitably  become  ner- 
vously concerned  at  the  advertisements  which 
the  quacks,  who  prey  upon  the  youth,  will  place 
in  his  hands.  He  should  be  told  the  importance 
of  sexual  continence  as  set  down  in  the  previous 
chapter.  He  should  be  taught  that  self-control 
is  a  sign  of  manliness  and  strength,  not  of  ef- 
feminacy and  weakness.  It  is  the  boy  of 
strength  and  courage  who  declines  his  com- 
rade's challenge  to  indulge  in  alcoholics  and 
visit  lewd  women ;  it  is  the  weak  boy  who  cannot 
decline.    He  should  be  taught  to  have  confidence 

92 


THE    SOCIOLOGY    OF    HEALTH 

in  Ms  parents,  and  when  questions  come  np 
upon  which  he  desires  enlightenment  he  should 
feel  no  restraint  in  asking  advice  or  informa- 
tion. He  should  be  told  the  causes  and  the 
nature  of  the  venereal  diseases,  and  at  the  age 
of  eighteen  girls  should  be  taught  the  same. 

In  a  general  way  girls  should  be  taught  about 
the  same  as  boys,  but  particularly  in  reference 
to  the  things  which  concern  them.  Menstrua- 
tion should  be  explained.  On  the  whole,  they 
require  less  instruction  in  these  lines  than  do 
boys.  The  girl  at  puberty  should  be  taught  the 
sig-nificance  of  love  and  sexual  feelings.  She 
should  know  the  meaning  of  the  strange  emo- 
tions that  fill  her  mind.  The  value  of  this 
knowledge  to  red-blooded  girls  may  not  be  ap- 
preciated by  asexual  dames,  but  it  is  a  matter 
of  vital  importance.  They  should  be  taught 
the  danger  of  permitting  liberties  with  their 
persons.  They  should  know  the  meaning  of  the 
mating  instinct  and  their  interest  in  boys. 
Could  we  lay  bare  the  story  of  the  debauching 
of  young  girls  we  should  realize  into  how  great 
a  blessing  a  little  knowledge  might  be  turned. 

Youth  should  be  encouraged  to  have  an  inter- 
est m  wholesome  occupation  requiring  both 
physical  and  mental  application.    They  should 

93 


MEDICAL    SOCIOLOGY 

be  taught  to  have  ideals.  The  adoration  of 
great  and  good  men  is  a  splendid  outlet  for  a 
boy's  sentiment.  After  puberty  they  demand 
sentiment,  and  they  should  have  it.  Teach 
boys  chivalry.  Good  female  society,  games, 
dances,  amateur  theatricals,  and  an  occasional 
love  story  are  all  in  this  line,  and  help  to  round 
the  normal  youth.  Athletics  to  a  moderate  de- 
gree are  of  benefit,  particularly  if  supervised 
by  a  competent  instructor.  It  is  a  splendid 
thing  for  boys  to  have  pride  in  their  physical 
health,  to  cast  out  prudishness,  and  to  be 
made  to  strip  occasionally  for  weighing,  meas- 
urements, and  inspection.  Athletics  of  this 
sort  make  for  chastity.  "  Frisch,  frei,  f rolich, 
fromm,"  the  Germans  say.  Above  all,  boys 
should  be  taught  the  fallacy  of  the  so-called 
"  sexual  necessity,"  and  the  danger  and  absurd- 
ity of  the  old  idea  of  "  sowing  wild  oats."  The 
boy  should  know  that  there  is  no  more  need  for 
him  to  "  sow  wild  oats  "  than  there  is  for  his 
sister  to  do  so. 

Both  boys  and  girls  should  know  that  there  is 
a  bad  side  to  life.  It  is  not  true  that  all  is  good 
and  beautiful.  In  due  time  they  should  be 
warned  that  there  are  unfortunate  women  who 
prey  upon  men  and  boys,  and  that  there  are 

94 


THE    SOCIOLOGY    OF    HEALTH 

men  who  make  girls  their  victims.  Girls  should 
be  taught  the  sacredness  of  their  bodies  and  the 
wiles  by  which  advantage  is  taken  of  them. 
Youth  should  know  that  the  women  who  lead 
lives  of  sexual  looseness  are  not  happy  in  it. 
Their  lives  are  short  and  their  ends  are 
wretched. 

Above  all,  teach  the  youth  reverence  for  his 
mother.  It  is  one  of  the  greatest  powers  to 
hold  him  to  the  right.  Let  him  know  all  that 
she  has  meant  to  him;  how  that  he  was  once  a 
part  of  her  very  body;  how  she  bore  him  with 
pains;  how  she  nourished  him  from  her  sub- 
stance; how  she  was  with  him  through  all  the 
dark  nights  and  watched  by  his  bedside;  and 
how  that  her  love  is  the  greatest  of  all.  He  will 
do  it  for  her — live  the  right  life. 

There  are  superstitions  which  militate  against 
attaining  the  best  results  in  teaching  sexual  hy- 
giene to  the  yo-ung.  I  do  not  refer  to  the  doc- 
trine that  the  body  is  but  a  vulgar  earthly 
thing,  to  be  sloughed  off  in  joy,  and  that  we 
should  give  no  thought  of  it — this  is  now  but 
little  taught  and  less  believed — but  I  refer  to 
the  doctrine  that  sins  committed  against  the 
body  of  oneself  or  another  can  be  expunged. 
Let  us  teach  that  sin  provides  its  own  punish- 
8  95 


MEDICAL    SOCIOLOGY 

ment,  and  that  when  once  committed  it  is  irre- 
trievable. We  are  pmiished  by  our  sins.  For- 
giveness, in  the  religions  sense,  is  the  rock  upon 
which  much  morality  is  shattered.  Let  us  not 
delude  the  young  with  the  fatuous  hope  that 
after  the  commission  of  sin  there  is  something 
that  can  be  done,  some  one  to  whom  to  go  who 
can  make  it  all  right  and  wipe  away  the  past. 
Such  a  teaching  is  immoral.  The  past  cannot 
be  expunged.  Let  us,  instead,  teach  the  young 
the  fear,  or  rather  the  respect,  for  consequences. 
Teach  them  that  these  venereal  diseases  are  not 
the  punishments  for  depravity,  but  that  they 
are  natural  consequences.  Above  all,  let  us  be 
reasonable— it  is  the  easiest  course.  Physical 
morality  is  the  morality  we  are  dealing  with. 
The  morality  which  has  not  a  physical  basis 
does  not  concern  us.  It  needs  no  vague  and 
esoteric  grounds  of  appeal  when  we  can  teach 
the  youth  what  is  best  for  him  and  his  happi- 
ness. A  noble  expediency  is  that  which  teaches 
the  child  to  be  mindful  of  what  is  best  for 
himself. 

The  lines  of  teaching  that  will  help  the  child 
must  be  practical  and  reasonable.  The  Church 
has  asked  that  children  be  taught  the  religious 
superstitions.    They  have  been  tried  and  they 

96 


THE    SOCIOLOGY    OF   HEALTH 

have  failed  egregiously.  If  the  Church  desires 
to  teach  the  things  that  will  help  the  child,  let 
it  desist  from  the  imnatural  and  unintelligible ; 
let  it  cease  in  its  glorification  of  the  doings  of 
an  obscure,  unprogressive,  and  uncultured  na- 
tion— long  since  gone  down  to  extinction — with 
its  wars  and  killings  and  intrigues  and  shame- 
ful superstitions ;  and  if  it  wants  to  teach  about 
God,  let  it  be  of  the  great  God  of  nature,  and 
not  of  the  wrathful  Jehovah  whose  delight  was 
in  the  slaying  of  the  innocent  and  in  holding 
personal  communications  with  lustful  men. 
There  is  more  enlightenment,  culture,  and  won- 
derment in  reading  the  message  written  in 
the  swirling  planets,  in  the  sprouting  seeds,  in 
the  unfolding  petals,  in  the  growing  egg,  in  the 
flight  of  birds,  in  the  tiger's  skin,  and  in  the 
mother's  love,  than  there  is  in  the  fanciful  writ- 
ings of  interested  and  superstitious  men  who 
have  made  credulous  humanity  believe  that  they 
were  handing  down  a  message.  If  we  want  the 
child  to  have  the  word  of  God,  let  him  be  taught 
to  read  it  himself  at  first  hand;  and  let  him 
study  the  lives  of  men  and  women  who  were 
really  wise,  practical,  and  good,  and  whose  ex- 
amples it  would  be  both  possible  and  wise  for 
him  to  follow. 

97 


MEDICAL    SOCIOLOGY 

Let  us.  furtliermore.  bear  in  mind  that  it  is 
knowledge  of  the  real  things  that  is  to  save  our 
youth  and  not  prudery.  I  have  known  boys  and 
girls  eager  for  information,  with  the  simple 
hearts  of  children,  to  have  their  questions  evad- 
ed by  their  parents — denied  the  knowledge  that 
might  have  saved  them  lives  of  misery — put  off 
with  platitudes.  Ignorance  is  not  innocence.  A 
father  brought  his  only  son,  eighteen  years  old, 
to  a  boarding  schooL  He  said:  "My  son  has 
always  had  a  private  tutor.  He  is  as  innocent 
as  when  he  was  a  babe.  I  have  brought  him 
here  because  you  have  no  bad  boys.  I  want  him 
keiDt  pure." 

The  following  are  the  facts  about  the  boy: 
At  the  time  these  words  were  spoken  he  had 
been  practicing  onanism  for  three  years.  On 
his  return  home  for  his  summer  vacation  he 
took  with  him  an  attack  of  gonorrhea  acquired 
from  a  lewd  woman.  Eight  years  later,  having 
graduated  from  college,  he  was  married  to  a 
beautiful  girl  full  of  hope  and  joy  in  the  prom- 
ises of  life.  She  was  operated  upon  for  gonor- 
rheal salpingitis  within  a  year  after  a  gorgeous 
wedding.  Ten  years  have  now  elapsed;  she  is 
still  a  semi-invalid.  The  father  has  said  that 
it  was  a  shame  that  his  son  had  made  such  a 

98 


THE    SOCIOLOGY    OF    HEALTH 

mistake  and  married  a  sickly,  sterile  wife; 
and  the  law  makes  it  a  crime  for  the  physician 
to  tell  this  silly  old  man  the  truth  because  it 
would  be  violating  the  professional  confidence 
of  the  patient.  Why  should  not  this  young 
man  have  been  given  the  simple  knowledge 
necessary  to  save  his  home  and  happiness! 
He  should,  and  the  girl,  too.  Youth  should 
know  the  meaning  of  the  sexual  craving  in  or- 
der to  know  best  how  to  protect  itself  from  mis- 
takes. The  average  boy  is  sensible  and  appre- 
ciates what  is  good  for  him  if  he  is  given  a 
fair  chance.  The  average  man  wants  to  do 
right.  He  does  not  want  venereal  disease,  nor 
does  he  want  to  transmit  it  to  another.  He  does 
not  want  a  sick  wife.  He  would  not  be  prone  to 
fall  into  sexual  errors  did  he  but  understand. 
In  dealing  with  the  young,  let  us  give  rea- 
sons. The  boy's  mind  is  a  man's  mind  and  it 
demands  reasons.  Arbitrary  dicta  belong  to 
the  field  and  camp,  but  not  to  the  home  and  the 
school.  Let  us  deny  the  child  no  truth  that  can 
serve  him.  Not  legislation,  nor  fairy  tales,  but 
education  is  the  solution  of  this  problem.  Vio- 
lations of  the  health  of  the  body  are  moral  sins 
in  which  no  remedy  is  so  effective  as  the  simple 
knowledge  of  the  truth. 

99 


SEXUAL   MOEALITY   AND   THE    STATE 

THE  widespread  existence  of  venereal 
diseases  as  results  of  sexual  immoral- 
ity, and  their  importance  as  factors 
affecting  the  homes  and  the  physical  efficiency 
of  citizens,  together  with  their  importance  as 
factors  productive  of  classes  which  become  a 
burden  upon  the  community,  all  make  these  con- 
ditions of  economic  significance  to  the  state. 
The  state  recognizes  the  necessity  for  the  con- 
trol and  supervision  of  measles,  scarlet  fever, 
and  smallpox.  Children  with  these  diseases  are 
debarred  from  school  and  forbidden  contact 
with  others.  The  state  lends  its  aid  in  the  fight 
against  tuberculosis,  but  the  venereal  diseases 
in  most  communities  are  not  recognized  by  the 
law  notwithstanding  that  their  destructive  ef- 
fects are  greater  than  all  of  these  other  diseases 
combined. 

In  the  United  States  one  factor  receives  offi- 
cial attention — that  is,  the  prostitute.     She  is 

100 


THE    SOCIOLOGY   OF   HEALTH 

segregated,  taxed,  regulated,  forbidden,  arrest- 
ed, fined,  imprisoned,  scorned,  and  cursed. 
Who  is  she  and  what  has  she  done  that  she 
should  be  visited  by  the  contumely  of  society? 
She  has  gratified  men.  Still  there  is  many  an 
honorable  wife  who  has  no  higher  function  in 
the  world  than  this.  What  brought  her  to  her 
lowly  occupation?  Several  causes,  the  most 
important  of  which  are  the  following:  She 
loved  a  man  who  pretended  that  he  loved  her; 
he  extorted  from  her  all  that  she  had  to  offer 
and  cast  her  aside;  society  spurned  her;  she 
knew  but  one  way  to  earn  a  living  and  in  her 
desperation  she  turned  to  it.  Another  was 
forced  to  it,  as  a  last  resort,  by  poverty  to  sup- 
port herself  or  her  family.  Another  was  driven 
to  it  by  parents,  husband,  or  guardian.  An- 
other was  made  intoxicated  and  debauched,  and 
discovered  that  from  that  day  on  the  compan- 
ionship of  good  women  was  denied  her.  An- 
other was  made  the  victim  of  a  systematically 
laid  trap;  she  was  caught,  and  ever  after  re- 
garded herself  as  unclean.  Another  coveted 
fine  raiment  and  jewels;  she  envied  the  rich 
who  had  them;  she  read  each  day  in  the  great 
daily  papers  of  the  sexual  irregularities  of 
those  who  wore  these  fine  things;  the  two  be- 

101 


MEDICAL    SOCIOLOGY 

came  inseparably  associated  in  her  mind;  tlie 
opportunity  to  combine  them  was  offered  to 
her;  she  accepted  it.  Another  fell  because  the 
great  passion  welled  through  her  being  so  that 
she  could  not  control  it;  she  loved  the  imita- 
tions of  love;  no  one  had  ever  told  her  their 
significance.  Another  inherited  an  unbalanced 
nervous  organism ;  the  strange  conditions  which 
men  call  by  the  name  of  degeneracy  were  be- 
queathed to  her ;  she  was  lacking  in  moral  per- 
spective and  appreciation  of  values. 

When  any  of  the  above  conditions  exist,  it 
is  made  easy  for  a  woman  to  fall.  The  down- 
ward path  seems  the  only  one,  for  on  every  side 
she  is  hemmed  in  by  men — men  everywhere, 
who  beckon  her  on  and,  leaving  her,  push  her 
farther  on  her  way.  She  cannot  escape  them. 
They  have  demanded  her,  surrounded  her,  and 
made  her  what  she  is. 

Every  one  of  these  women  is  the  victim  of 
defective  education.  Had  most  of  them  known 
the  simple  truths  concerning  sexual  physiology 
and  hygiene,  the  meaning  of  sexual  passion,  the 
dangers  of  venereal  diseases,  and  been  taught 
the  real  interests  of  life,  society  would  have 
been  saved  their  loss.  This  is  personally  true 
of  all  but  the  degenerate,  and  in  her  case  the 

102 


THE    SOCIOLOGY   OF   HEALTH 

same  lessons  should  have  been  tanght  her  for- 
bears. There  are  ten  thousand  prostitutes  in 
New  York  now  who  came  from  respectable 
homes,  who  are  the  daughters  of  loving  moth- 
ers, and  there  are  ten  thousand  little  girls  now 
happily  playing  with  their  dolls  by  their  moth- 
ers' sides  who  are  to  grow  up  and  take  the 
places  of  these  when  they  have  been  swallowed 
up  by  the  great  consuming  maelstrom  of  the 
city.  It  is  not  for  the  ten  thousand  prostitutes 
that  we  need  be  most  concerned — they  are  lost; 
but  the  ten  thousand  little  girls  are  worth  sav- 
ing. Ask  their  mothers  if  they  are  not.  The 
most  important  factors  for  their  salvation  are 
education  and  knowledge.  Let  its  light  fall 
upon  the  dark  places.  Ignorance  is  not  better 
than  knowledge.  The  next  important  thing  is 
better  social  and  economic  conditions.  When 
every  one  who  wants  to  work  shall  have  work 
and  fair  compensation  for  it ;  when  every  adult, 
male  and  female,  does  his  or  her  quota  of  work ; 
when  the  aim  of  education  is  to  prepare  for 
life,  healthfulness,  and  efficiency,  and  not  for 
college,  idleness,  or  death;  when  every  healthy 
man  who  wants  to  marry  may  marry, — then 
education  will  do  the  rest,  and  the  venereal 
plague  will  be  overcome.    Idle  women  and  bad 

103 


MEDICAL    SOCIOLOGY 

women  are  often  so  through  lack  of  education. 
Education  helps  by  filling  empty  brains.  Give 
a  woman  knowledge  of  the  vital  and  interest- 
ing things  about  her  and  she  is  not  apt  to  de- 
generate. 

Two  interesting  features  of  this  subject 
should  not  be  overlooked:  One  is  the  fact  that 
while  the  laws  regulate  the  prostitute,  the  male 
offender,  who  is  her  cause,  her  patron,  and  the 
vehicle  by  which  her  diseases  are  conveyed  to 
the  innocent — the  male  offender  may  go  his 
way,  and  the  law  wishes  him  Godspeed.  It  is  as 
though  we  should  regulate  the  plague  by  shut- 
ting up  the  women  and  allowing  the  men  to  go 
free.  Another  important  feature  of  this  ques- 
tion is  that  the  chief  patron  of  the  house  of 
prostitution  is  the  married  man.  This  fact 
takes  us  back  to  the  social  and  economic  con- 
ditions of  the  home,  which  must  be  remedied  be- 
fore these  matters  of  the  sexes  can  ever  be 
adjudicated. 

Another  matter  which  the  state  has  in  its 
power  to  regulate  is  the  alcohol  question.  Al- 
cohol is  the  seducer's  ally.  It  has  the  power 
to  paralyze  the  inhibitive  centers;  it  causes  a 
blunting  of  the  moral  sense  and  of  the  willful 
control  of  conduct ;  it  subjugates  the  higher  fac- 

104 


THE    SOCIOLOGY    OF    HEALTH 

iilties  and  leaves  the  animal  passions  to  follow 
their  iincurbed  inclinations.  Of  all  the  active, 
extrinsic  agencies,  it  is  the  greatest  for  sexual 
harm.  The  dance  hall  is  a  public  necessity,  but 
introduce  alcohol  and  it  becomes  the  antecham- 
ber of  the  brothel.  When  the  public  comes  to 
understand  the  relations  of  alcohol  to  the  sex- 
ual sins,  a  long  step  will  have  been  taken  toward 
the  overcoming  of  both  of  these  evils. 

The  evil  influences  of  the  theater,  where  sex- 
ual immoralities  are  presented  in  an  artistic 
and  attractive  setting,  is  a  matter  with  which 
the  municipalities  are  failing  to  cope.  The 
moving-picture  shows  have  become  a  positive 
menace  in  most  cities  in  America.  They  at- 
tract children  and  the  young.  Many  of  the  ex- 
hibitions are  degrading,  showing  every  variety 
of  sexual  vice.  Young  boys  and  girls  are  wit- 
nessing moving  pictures  showing  men  and 
women  in  the  act  of  sexual  intercourse.  Chi- 
cago has  just  caused  these  lewd  exhibits  to  be 
stopped,  but  they  opened  business  in  a  neigh- 
boring city.  It  was  observed  that  the  school- 
boys in  one  neighborhood  in  New  York  fre- 
quented these  cheap  shows  on  Saturdays.  The 
gymnasium  and  playgrounds  of  one  of  the 
schools  which  had  always  been  closed  on  that 

105 


MEDICAL    SOCIOLOGY 

day  were  thrown  open,  with  the  result  that  the 
boys  patronized  the  school  grounds  instead  of 
the  shows.  Playgrounds  and  breathing  places 
where  youth  can  work  off  its  energy  are  essen- 
tial for  good  results. 

Venereal  diseases  place  an  enormous  bur- 
den upon  the  state.  Blindness,  insanity,  deaf- 
mutism,  epilepsy,  idiocy,  degeneracy,  and  crime 
follow  in  their  path.  At  least  one  fourth  of 
our  public  institutions  for  caring  for  defectives 
is  made  necessary  by  venereal  diseases. 

These  diseases  play  an  important  role  as  a 
cause  of  divorce.  The  statistics  show  "  incom- 
patibility," "  cruelty,"  "  nonsupport,"  and  other 
more  genteel  causes,  when  behind  it  all  lies  the 
real  cause — venereal  disease  which  has  ren- 
dered the  wife  unattractive,  or  which  has  be- 
trayed the  infidelity  of  the  husband. 

One  of  the  most  important  steps  in  the  eman- 
cipation of  woman  is  to  relieve  her  from  the 
position  of  subjection  to  man.  When  public  sen- 
timent overcomes  the  fallacy  of  the  "  double 
standard  "  of  sexual  morals,  and  makes  it  as 
much  of  a  reproach  for  the  man  to  bring  gon- 
orrhea into  the  home  as  for  the  woman,  and 
when  women  have  an  intelligent  attitude  toward 
these  matters,  based  on  knowledge,  and  are  not 

106 


THE    SOCIOLOGY    OF    HEALTH 

simply  supposed  to  be  dependents  to  take  what- 
ever the  husband  gives  them — then  we  shall  be 
approaching  the  ideals  of  civilization. 

The  monogamous  household  must  be  recog- 
nized as  the  greatest  civilizing  influence.  Men 
have  created  the  standard  of  special  masculine 
privileges  because  they  had  the  power  to  create 
it.  Now  they  are  going  to  relinquish  it  because 
they  have  the  chivalry,  honor,  and  good  sense 
to  see  that  it  is  both  unfair  and  dangerous. 

A  word  concerning  literature  in  its  relation 
to  this  subject.  The  freedom  of  the  press  costs 
us  a  great  price.  One  of  the  New  York  dailies 
was  recently  forbidden  entry  into  the  mails 
for  maintaining  a  so-called  personal  column 
which  was  but  a  thinly  veiled  advertisement  of 
schemes  for  the  debauching  of  women.  The 
advertising  columns  of  the  daily  papers  of 
many  of  our  cities  are  a  disgrace  to  these  com- 
munities. They  carry  the  advertisements  of 
that  great  class  of  criminals  who  prey  upon  the 
misfortunes  which  they  seek  to  create.  Young 
men  find  no  small  encouragement  in  the  re- 
peated announcements  of  sure  cures  for  the 
troubles  into  which  their  wrongdoings  might 
bring  them.  The  girl  pressed  to  the  point  when 
she  is  about  to  fall  may  yield  when  confronted 

107 


MEDICAL    SOCIOLOGY 

by  the  advertisement  vaunting  the  virtues  of 
the  preventer  of  conception.  The  presence  of 
these  immoral  and  fraudulent  things,  flaunted 
daily  in  the  face  of  the  public,  is  a  standing 
menace  and  reproach. 

In  most  countries  the  time  is  not  yet  ripe  for 
compulsory  reporting  of  contagious  venereal 
diseases  to  the  health  authorities.  It  must  be 
preceded  by  education.  No  law  is  effective  un- 
less the  people  understand  it  and  are  in  sym- 
pathy with  it.  The  privileged  communication, 
the  interests  of  the  patient,  the  rights  of  the 
individual  all  stand  in  the  way.  While  the 
venereal  diseases  are  more  dangerous,  and  are 
doing  more  damage  to  the  human  race  than 
leprosy,  plague,  smallpox,  and  scarlet  fever 
combined,  the  fact  that  they  carry  with  them  a 
stigma  makes  reporting  them  difficult.  If  they 
were  made  reportable,  many  patients  would  not 
present  themselves  to  the  reputable  physician 
for  treatment,  but  would  frequent  the  quack. 
Some  states  have  required  reporting  without 
giving  the  name  of  the  patient.  This  does  not 
accomplish  results.  Ultimately  these  diseases 
must  be  reported.  The  state  must  know  how 
prevalent  they  are  and  where  they  are  most 
prevalent  in  order  to  apply  remedies.    Treat- 

108 


THE    SOCIOLOGY   OF   HEALTH 

ment  must  be  made  easier.  The  quacks  must 
be  driven  out;  they  breed  venereal  diseases. 
Berlin,  Dresden,  and  a  few  other  cities  require 
that  prostitutes  shall  be  examined  at  frequent 
intervals  and  sent  to  the  hospital  if  found  with 
infective  disease.  This  has  never  been  satis- 
factory, as  the  women  may  become  infected 
within  an  hour  after  receiving  a  bill  of  health; 
and  when  we  realize  that  some  of  these  women 
accommodate  ten  or  twenty  men  a  day,  the 
weakness  of  the  method  becomes  apparent. 

But  one  thing  the  state  can  do,  and  now:  it 
can  demand  a  clean  bill  of  health  from  the  man 
who  applies  for  a  marriage  license.  The  inno- 
cent wife  is  the  one  who  too  often  reaps  the 
wild  oats  sown  by  the  husband.  The  state  owes 
it  to  her  to  see  to  it  that  the  marriage  con- 
tract, with  which  it  is  so  much  interested,  shall 
carry  with  it  a  guarantee  of  safety.  When  a 
woman  yields  herself  up  for  motherhood,  she 
is  rendering  the  greatest  service  that  anyone 
can  perform  for  the  state,  and  she  above  all  of 
a  country's  charges  should  be  protected.  The 
nations  that  throw  this  safeguard  about  their 
women  are  destined  to  march  in  the  van  of 
human  progress.  If  the  state  is  not  ready  to 
take  cognizance  of  every  man  with  gonorrhea 

109 


MEDICAL   SOCIOLOGY 

or  syphilis,  as  it  now  does  in  the  case  of  every 
man  with  smallpox  or  scarlet  fever,  it  at  least 
must  be  ready  to  prevent  him  from  deliberately 
transmitting  these  diseases  to  another  when  he 
signifies  his  intention  so  to  do. 

American  cities  can  do  little  good  by  licens- 
ing and  hounding  the  prostitute.  ^Miere  this 
has  been  done  the  jDolice  and  politicians  have 
taken  her  earnings.  In  New  York  City  are 
at  least  30,000  prostitutes  whose  earnings  are 
over  $60,000,000  a  year.  The  amount  of  vene- 
real disease  which  they  diffuse  is  incalculable. 
Leckey's  view  of  the  prostitute  as  a  necessity 
must  be  made  obsolete.  Municipalities  can  bet- 
ter devote  their  energies  to  teaching  and  warn- 
ing against  her  than  in  regulating  her  business. 
Education  is  cheaper  and  more  effective.  If 
men  knew  as  much  of  her  as  of  the  latest  mur- 
der trial  her  business  would  forsake  her.  Let 
the  state  turn  away  from  the  prostitute  and 
interest  itself  in  her  patrons  and  in  the  vicious 
conditions  which  have  produced  her — this  piti- 
ful woman  of  whom  Hafiz  said,  "  Bride  of  a 
thousand  bridegrooms  hath  she  been." 

Prevention  of  venereal  diseases  is  most  need- 
ed. If  any  animal  industry  were  afflicted  with 
this   scourge,  the   state  would  be  aroused  to 

110 


THE    SOCIOLOGY   OF   HEALTH 

strenuous  activity,  and  neither  pains  nor  money 
would  be  spared  to  stamp  it  out.  But  this 
blight  affects  our  sons  and  daughters,  not  our 
sheep  and  hogs,  and  the  state  raises  but  a 
feeble  voice  against  it.  Norway  and  Sweden 
made  venereal  diseases  reportable,  circulated 
pamphlets  of  instruction,  and  reduced  their 
prevalence  thirty-four  per  cent.  This  country 
must  eventually  do  the  same.  We  should  have 
tangible  data.  The  subject  should  be  discussed 
— it  thrives  in  darkness  and  silence.  Typhoid 
and  tuberculosis  are  being  overcome  by  discuss- 
ing them  and  by  disseminating  knowledge  con- 
cerning them.  Curative  medicine  is  in  the 
hands  of  the  medical  profession,  but  preventive 
medicine  must  be  in  the  hands  of  the  public. 
The  diseases  of  society  cannot  be  healed  with- 
out publicly  speaking  of  them.  These  diseases 
thrive  on  prudishness,  ignorance,  and  the  be- 
neficent passion  by  which  the  race  is  kept  alive. 
Prudishness  must  give  place  to  candor  and  hon- 
esty; ignorance  must  be  overcome  by  promul- 
gating the  facts  and  furthering  the  teaching  of 
sexual  hygiene ;  and  passion  must  be  guided  by 
knowledge. 


XI 

SEXUAL    CONTINENCE 

SOMETIME  after  having  discussed  the 
subject  of  sexual  morality,  I  received 
the  following  communication,  which  is 
worthy  of  serving  as  a  text  for  some  further 
elucidation  of  this  subject. 

"  I  heartily  agree  with  all  that  you  say  con- 
cerning sexual  morality.  I  do,  however,  wish 
to  ask  a  question  concerning  some  points  of  the 
subject.  May  I  ask  what  are  you  going  to  say 
for  the  unmarried  man  who  has  sexual  pas- 
sion and  is  desirous  of  leading  a  decent  life — 
a  man  to  whom  every  suggestive  look  from 
amorous  women,  every  lascivious  picture  he 
sees,  and  the  subtle  influences  that  meet  him 
on  every  side,  all  conspire  to  inflame  his 
senses. 

"  You  may  say  to  the  unmarried  man  to  find  a 
wife.  There  may  be  good  reasons  why  he  should 
not  get  one.  How  shall  such  a  person  not  be 
disturbed  by  vain  longings  by  day  and  erotic 

112 


THE    SOCIOLOGY   OF   HEALTH 

dreams  by  night  ?  I  grant  you  that  the  proper 
teaching  of  the  child  early  in  life  will  help  to 
enable  him  to  control  his  sexual  nature,  but 
what  about  the  man  who  went  into  the  world  in 
ignorance  and  learned  all  that  he  knows  of  sex- 
ual things  from  his  companions  1 

"Lots  of  men  do  not  care  enough  about 
sexual  matters  to  be  bothered;  but  there  are 
many  who  see  the  error  of  their  habits,  who 
desire  to  reform,  and  to  whom  this  means 
the  fight  of  their  lives.  What  do  you  say  for 
them?" 

The  conditions  represented  in  this  communi- 
cation are  by  no  means  uncommon.  They  are 
real  conditions,  and  must  be  met  in  a  practical 
way  and  not  vaguely.  In  the  first  place,  let  it 
be  understood  that  the  best  interests  of  the  in- 
dividual demand  that  man  shall  cohabit  with 
none  but  his  wife.  If  a  woman  is  not  his  wife 
he  shall  not  cohabit  with  her.  Infringement 
of  this  rule  is  fraught  with  dangers,  which 
have  been  enumerated  in  the  preceding  chap- 
ter. One  very  important  thing  is  that  the 
minds  of  these  men  must  be  disabused  of  the 
fallacy  of  the  sexual  necessity.  The  exercising 
of  the  sexual  functions  is  absolutely  not  neces- 
sary for  a  man's  health.    Continent  men  as  well 

113 


MEDICAL    SOCIOLOGY 

as  physicians  know  this.  Moreover,  the  best 
preparation  for  continence  is  continence.  The 
sexual  glands  do  not  weaken  from  disuse  any 
more  than  do  the  tear  glands.  Good  general 
health  is  the  most  important  means  of  preserv- 
ing sexual  vigor.  Excessive  sexual  activity  de- 
stroys it. 

Concerning  the  specific  case  in  question — the 
man  who  yields  to  what  he  knows  is  wrong  and 
harmful — there  is  just  one  thing  for  him  to  do, 
and  that  is  to  stop.  If  he  desires  to  correct  his 
habits,  but  does  not,  and  is  much  in  a  state  of 
sexual  excitement,  then  I  should  say  that  one  or 
more  of  three  things  is  the  trouble :  he  is  either 
suffering  from  idleness,  the  prime  promoter  of 
vice ;  his  education  and  knowledge  of  the  simple 
things  are  defective;  or  he  has  a  mental  defect 
which  should  receive  consideration  from  the 
neurologists. 

A  man  who  has  a  serious  hold  on  the  essen- 
tials of  life,  and  who  is  busy  with  useful 
work,  as  every  man  should  be,  whose  mind  is 
occupied  with  thoughts  of  wholesome  interests, 
or  whose  time  is  consumed  by  his  vocation, 
does  not  suffer  the  sexual  dangers  inherent  in 
idleness. 

Every  man  should  have  a  knowledge  of  the 
114 


THE    SOCIOLOGY   OF   HEALTH 

anatomy  and  physiology  of  the  sexual  organs, 
and  he  should  be  familiar  with  the  meaning  and 
dangers  of  venereal  disease,  and  also  with  the 
objections  to  extramarital  venery.  If  he  is  not, 
his  education  in  the  simple  essentials  is  defec- 
tive. The  prudishness  which  deprives  young 
men  of  this  knowledge  is  decidedly  immoral  in 
its  results.  The  Japanese,  among  whom  men 
and  women  innocently  bathe  in  the  same  pool, 
are  free  from  prudishness  and  from  the  vulgar 
sense  of  suggestiveness  at  the  sight  of  feminine 
curves,  which  characterize  the  ogling  Occiden- 
tals. For  the  same  reason  a  boy  brought  up 
among  sisters  has  less  of  this  pernicious  pru- 
dishness which  covets  the  sight  of  hidden 
charms.  Carlyle  has  said  that  the  beginning  of 
wisdom  is  to  look  on  clothes  till  they  become 
transparent.  The  person  to  whose  eye  they 
cover  a  great  and  elusive  mystery  is  not  well 
educated. 

To  answer  the  question,  What  is  this  man 
going  to  do  about  it?  is  as  easy  as  answering 
the  question.  What  is  the  kleptomaniac  who 
wants  to  stop  stealing  going  to  do  about  if?  He 
should  stop;  and  if  he  does  not,  he  should  re- 
ceive the  attentions  which  a  mental  defective 
merits. 

115 


MEDICAL    SOCIOLOGY 

As  to  the  healthy  man,  let  such  a  man,  first, 
be  busy;  and,  second,  let  him  resolve  upon  the 
course  which  he  desires  to  pursue.  With  fixed 
determination,  a  sane  man  can  do  about  what 
he  pleases.  I  know  an  unmarried  man  who  has 
said  to  himself,  "  I  shall  marry  some  day ;  some- 
where in  the  world  a  woman  is  keeping  her 
chastity  inviolate  for  me;  and  I  shall  do  the 
same  for  her."  With  this  philosophy  he  dis- 
misses the  subject  from  his  mind;  the  matter 
is  disposed  of ;  he  does  not  bother  his  head  with 
sexual  debates;  the  question  is  settled;  it  can- 
not come  up  for  reconsideration;  and  he  gives 
himself  and  his  energies  entirely  to  other  mat- 
ters. It  is  a  splendid  thing  for  a  man  to  pro- 
nounce a  final  settlement  upon  an  important 
question  which  otherwise  might  constantly  re- 
cur and  harass  his  mind.  The  man  with  a  de- 
termined principle  has  clear  sailing.  A  course 
of  conduct  then  becomes  easy.  It  is  the  unfor- 
tunate weakling  who  has  not  decided  his  ques- 
tions, and  the  man  who  does  not  want  to  decide 
them,  who  keep  themselves  in  hot  water. 

Let  these  men  in  question  make  themselves 
healthy,  live  hygienically,  discard  vicious  and 
harmful  habits,  and  they  will  have  taken  the 
first    step    toward    eliminating    the    physical 

116 


THE    SOCIOLOGY    OF    HEALTH 

sources  of  vice ;  let  them  have  an  understanding 
of  the  causes  and  effects;  then  let  them  purge 
their  minds  of  lust,  and  establish  in  its  place 
thoughts  of  better  things  and  clearly  defined 
principles ;  and  the  victory  is  won. 


XII 

IDLE    WIVES,    UNMATED    MEN,    AND    THE 
VENEREAL   PERIL 

THE  question  of  sexual  immorality  and 
the  venereal  peril  is  by  no  means  a 
simple  one ;  and  because  of  its  complex- 
ity the  remedy  can  be  said  to  lie  in  no  single 
expedient.  There  is  the  one  great  cause  which 
we  cannot  change,  nor  would  we  if  we  could — 
the  sexual  instinct.  There  are  certain  social  con- 
ditions, however,  which  may  properly  be  re- 
garded in  the  light  of  contributing  causes,  the 
elimination  of  which  would  constitute  a  long 
step  in  the  direction  of  sexual  purity.  To  one 
of  these  alone  I  desire  to  call  attention.  It  is 
not  wine,  nor  idleness,  nor  the  absence  of 
proper  instruction  in  childhood,  nor  lewd  com- 
panions, nor  the  easy  accessibility  and  preva- 
lence of  women  of  moral  perversity,  nor  the 
waning  influence  of  the  Church — all  of  which 
have  been  held  accountable — ^but  it  is  the  social 
condition  which  postpones  normal  marriage. 

118 


THE    SOCIOLOGY    OF    HEALTH 

Here  again  we  encounter  complex  sociologic- 
al problems.  Among  these  the  most  important 
are  the  increasing  complications  and  concomi- 
tant expenses  of  domestic  life.  Men  have 
drifted  away  from  the  happy  old  habit  of  think- 
ing of  the  wife  as  an  helpmeet  to  the  habit  of 
treating  her  as  a  luxury,  to  be  maintained  at  a 
certain  necessary  expense,  just  as  one's  yacht 
must  be  maintained.  In  the  larger  towns  this 
condition  is  so  prevalent  that  in  many  commu- 
nities the  most  useful  women  are  the  unmarried 
ones,  and  for  a  woman  to  marry  is  to  retire  into 
the  seraglio  of  pampered  luxuries.  There  are 
whole  blocks  in  our  great  cities  in  which  the 
women  are  essentially  useless  creatures,  outside 
of  contributing  to  the  joy  of  their  husbands. 
They  do  not  even  have  the  elevating  responsibil- 
ity of  caring  for  their  own  hair  or  feet,  let  alone 
the  care  of  their  children  or  households.  The 
morning  bath,  the  novel,  the  luncheon,  the  drive, 
cards,  the  theater — the  home  cannot  thrive  by 
these.  Idleness  in  women  is  the  beginning  of 
trouble.  It  is  just  as  bad  for  their  morals  as 
it  is  for  men's — perhaps  a  little  worse. 

Every  young  business  man  who  would  lead 
the  normal  life  has  before  him  the  goal  of  his 
aspirations  in  business  success,  which  is  high 

119 


MEDICAL    SOCIOLOGY 

and  attained  by  few ;  and  also  the  domestic  out- 
fit which  goes  with  it,  which  usually  remains 
beyond  his  reach ;  and  marriage  is  postponed. 

The  household  is  not  upon  a  normal  basis  un- 
less the  woman  works  and  helps  the  man  main- 
tain it.  She  must  be  more  than  an  object  of 
ornamental  furniture.  She  should  be  engaged 
in  useful  occupation  within  the  limits  of  her 
strength.  Employment  which  is  not  useful  is 
idleness.  If  her  husband  can  afford  to  keep  her 
in  idleness,  it  is  to  insult  her  to  demand  that  she 
should  live  so.  The  woman  who  is  idle  degen- 
erates; and  her  household,  her  children,  the 
community,  and  her  husband  all  suffer  for  it. 
He  would  treat  his  horse  better  than  to  demand 
idleness  from  it.  And  yet  this  is  the  state  in 
which  many  young  men  think  a  wife  wants  to 
live,  and  few  young  men  can  afford  to  main- 
tain a  luxurious  appurtenance  of  this  sort,  at 
least  not  until  they  have  frittered  away  the 
most  precious  years  of  their  lives  making 
money  and  in  discovering  the  dangers  and  in- 
completeness of  bachelorhood. 

I  know  a  cultivated  woman  in  one  of  our  great 
cities  who  in  her  home  puts  in  as  many  hours  of 
work  as  she  requires  of  her  servants.  She  joy- 
ously labors  with  them,  doing  real  acts  of  phys- 

120 


THE    SOCIOLOGY    OF   HEALTH 

ical  toiL  She  is  the  companion  of  her  children, 
who  receive  from  her  those  attentions  which  a 
mother  best  can  give.  Still  usefulness  does  not 
deprive  her  of  the  pleasure  of  the  opera,  or  of 
a  participation  in  the  organized  works  for  social 
and  civic  betterment ;  and  when  she  is  heard  in 
the  discussion  of  social  questions  she  speaks 
from  real  knowledge.  But  here  is  the  interest- 
ing thing:  When  the  heavens  pour  forth  a  del- 
uge of  snow,  and  with  her  ruddy  boys  she  sal- 
lies forth,  shovel  in  hand,  to  clear  the  paths,  at 
the  neighboring  windows  appear  the  faces  of 
the  idle  women,  beholding  with  amazement,  sur- 
passing their  comprehension,  the  extraordinary 
spectacle  of  a  lady  of  social  station  engaged  in 
useful  manual  labor!  It  is  not  this  particular 
woman  who  points  the  moral,  but  it  is  the  other 
women  for  whom  we  are  concerned.  It  is  the 
fact  that  by  education  and  training  and  by  the 
usages  of  their  social  environment  they  are  out 
of  touch  and  sympathy  with  useful  labor  among 
women  who  might  avoid  it.  "With  them  it  is  a 
thing  to  be  escaped — escaped  through  the 
agency  of  marriage  or  inheritance.  And  in 
this,  society  is  just  as  cruel  to  them  as  organ- 
ized labor  has  been  to  condemned  prisoners — 
it  will  not  let  them  work.    The  idle  wives  of 

121 


MEDICAL    SOCIOLOGY 

society  are  as  expensive  as  are  the  idle  prison- 
ers of  the  state;  and  they  degenerate  just  as 
fast,  and  in  direct  ratio  to  the  degree  of  their 
idleness. 

This  condition  is  most  prevalent  in  the  large 
cities.  In  the  country,  a  larger  proportion  of 
the  women  are  useful,  and  for  that  reason  mar- 
riage is  less  expensive.  But  in  the  city,  the 
prevalence  of  the  practice  of  marrying  a  woman 
to  support  her  in  idleness  deters  the  young  man 
from  organizing  a  home ;  and  marriage  is  post- 
poned, with  evil  consequences. 

This  evil  will  not  be  overcome  until  the  rush 
to  the  cities  subsides  and  the  country  becomes 
economically  and  socially  attractive.  The  hud- 
dled life  of  the  city  is  not  well  adapted  for 
man's  advancement.  A  better  prosperity  is 
possible  in  the  less  crowded  communities.  The 
city  works  a  hardship  to  both  men  and  women. 
Its  allurements  deplete  the  country  of  the 
flower  of  its  young  manhood.  I  should  not 
blame  the  spinsters  of  New  England  if  they 
should  organize  and  en  masse  march  upon  Bos- 
ton, whence  the  boys  of  their  childhood  have 
gone,  with  banners  bearing  the  slogan,  "  We  de- 
mand our  birthright ;  we  demand  to  be  loved !  " 

But  before  this  desperate  expedient  is  re- 
122 


THE    SOCIOLOGY   OF   HEALTH 

sorted  to,  the  growing  improvements  in  commu- 
nication and  transportation  will  have  removed 
from  the  country  its  objection  of  remoteness, 
and  civilizing  education  will  have  made  its  ad- 
vantages take  the  place  of  the  disadvantages  of 
the  city.  Then  there  shall  be  a  larger  propor- 
tion of  productive  members  in  the  community; 
more  productive  labor  for  those  who  are  now 
idle;  more  profitable  leisure  for  those  who  now 
labor;  more  simple  life;  less  wastefulness;  and 
a  better  appreciation  of  the  things  that  are 
worth  while.  The  normal  life  should  then  be 
more  prevalent.  The  social  conditions  of  the 
city  also  should  improve.  It  should  be  easier 
for  married  women  to  be  useful.  The  financial 
burdens  of  the  home  should  be  reduced.  The 
roaming  about  of  unmated  men,  seeking  who 
may  devour  them,  should  be  less  prevalent ;  and 
a  great  cause  of  the  venereal  peril  overcome. 


xni 


THE   SOCIAL   EVIL 


THE  discussion  of  sexual  morality  has 
been  a  much-avoided  subject  until  very 
recent  times.  The  alarming  prevalence 
of  venereal  diseases  called  attention  to  the  ne- 
cessity for  discussion.  Then  it  was  found  that 
the  people  knew  really  little  of  sexual  hygiene. 
It  is  to  the  credit  of  the  medical  profession  that 
this  question  is  beginning  to  receive  the  atten- 
tion which  its  importance  merits.  Neglected  by 
the  Church,  posing  as  the  guardian  of  public 
and  individual  morality ;  ignored  by  the  school, 
from  which  the  child  should  receive  the  instruc- 
tion which  best  fits  him  for  happiness  and  use- 
fulness ;  and  avoided  with  prudish  cowardice  by 
the  parent,  whose  obligation  it  is  to  point  out 
the  path  by  which  the  child  should  walk — this 
question  of  sexual  morality  has  been  left  for 
elucidation  to  the  gamins  of  the  street  and  the 
habitues  of  the  brothel.  The  first  that  most 
children  learn  of  it  is  from  the  most  vulgar  of 

124 


THE    SOCIOLOGY    OF    HEALTH 

their  playmates.  This  most  important  subject 
is  first  taught  by  the  most  immoral  teachers.  It 
is  to  be  hoped  that  the  attention  now  being  given 
it  may  increase  in  power  and  in  results,  to  the 
end  that  the  neglect  which  it  has  suffered  may 
be  atoned  for. 

The  movement  to  educate  the  public  upon 
sexual  hygiene  and  save  youth  from  the  pitfalls 
of  ignorance  had  its  beginning  in  the  study  of 
venereal  diseases  and  their  direful  conse- 
quences ;  and  the  injuries  inflicted  by  these  dis- 
eases upon  the  innocent  have  aroused  the  sym- 
pathies of  students  of  this  class  of  maladies. 
The  committees  of  medical  societies  and  the 
societies  for  sanitary  and  moral  prophylaxis 
which  are  engaged  upon  these  questions  have 
before  them  a  work  of  greater  importance  than 
that  of  the  organizations  for  the  elimination  of 
tuberculosis. 

The  matter  has  been  taken  up  by  medical 
bodies  and  societies  under  medical  guidance. 
The  simple  truth  is  all  that  is  needed.  That 
will  make  us  free  from  the  ignorance  which  has 
lain  at  the  root  of  sexual  sias.  Sexual  physiol- 
ogy and  psychology  should  be  taught,  not 
vaguely  and  covertly  hinted  at.  The  fallacy  of 
sexual  necessity,   promulgated  by  the   sexual 

125 


MEDICAL    SOCIOLOGY 

sinner,  should  be  replaced  by  the  knowledge 
that  the  exercise  of  the  sexual  organs  is  not 
necessary  for  health.  The  prevalence  and  the 
direful  results  of  venereal  diseases  should  be 
known,  and  especially  their  consequences  to  the 
innocent.  And,  finally,  the  meaning  of  normal 
marriage  should  be  made  clear  to  all  young  men 
and  women.  Marriage  can  be  founded  neither 
upon  sexual  feeling  nor  platonic  affection;  it 
must  combine  mental  and  animal  harmony  in 
the  divine  passion  of  love  in  a  man  and  woman, 
each  inspired  by  the  spirit  of  mutual  helpful- 
ness and  a  desire  to  bring  out  and  develop  the 
best  qualities  in  the  other. 

The  teaching  of  the  things  which  are  neces- 
sary for  the  happiness  and  usefulness  of  the 
child  should  begin  at  home.  The  responsibility 
rests  upon  the  parent.  This  instruction  should 
be  continued  in  the  school ;  and  the  Church  and 
other  organizations  for  moral  instruction  can 
well  afford  to  devote  some  attention  to  the 
teaching  of  these  helpful  truths.  Education  is 
the  solution  of  this  problem. 

Seduction  and  promiscuous  sexual  inter- 
course were  not  only  not  frowned  upon,  but 
were  matters  of  parlor  conversation  as  recently 
as   the   time   of   Addison   and   the   Spectator. 

126 


THE    SOCIOLOGY   OF   HEALTH 

Drunkenness  did  not  exclude  a  man  from  good 
society  as  recently  as  the  Civil  "War  period. 
Tight  lacing,  unhealthy  pallor,  and  piercing  the 
ears  for  the  purpose  of  hanging  jewels  upon 
them  have  only  within  the  memory  of  the  young 
become  unpopular  among  cultured  people. 
The  advances  of  civilization  have  eliminated 
these.  The  period  now  dawning  is  to  be  charac- 
terized by  the  promotion  of  happiness  through 
the  care  and  perfection  of  the  human  body.  We 
are  to  recover  from  the  two  thousand  years  of 
neglect  of  the  flesh.  And,  in  the  interest  of 
sexual  health  and  morality,  it  is  surely  not  too 
much  to  hope  that  public  opinion  will,  during 
this  twentieth  century,  place  its  stamp  of  disap- 
proval upon  the  inequality  of  sexual  privilege 
now  prevalent,  and  demand  from  the  man  the 
same  measure  of  virtue  as  it  does  from  the 
woman. 


10 


XIV 

EDUCATION  AND  THE  HEALTH  AND  EFFICIENCY 
OF    GIRLS 

MANY  girls  return  from  school  or  col- 
lege in  a  bad  state  of  health  and  in 
need  of  vacation.  Many  girls  grow 
robust  while  in  school.  The  former  is  all  too 
common;  the  latter,  too  seldom.  Education,  if 
it  is  worth  being  called  education,  conduces  to 
good  health.  This  is  not  yet  freely  admitted, 
but  some  day  it  will  be.  There  was  never  a  time 
when  learning  things  that  have  been  written 
was  better  than  being  well. 

Our  systems  of  feminine  education  have  not 
yet  reached  a  point  in  their  development  when 
they  have  much  to  offer  beyond  a  smattering 
knowledge  of  certain  more  or  less  useful,  or 
useless,  facts  and  theories.  If  a  girl  belongs 
to  that  class  of  young  women  engaged  in  pre- 
paring for  college,  she  is  made  to  consume  some 
of  the  most  precious  years  of  her  life  memoriz- 
ing much  that  will  never  be  of  use  to  her  or 

128 


THE    SOCIOLOGY    OF   HEALTH 

ever  again  called  for  after  she  has  passed  her 
entrance  examinations.  It  really  has  not  been 
history  and  mathematics  that  she  has  been  cul- 
tivating, but  her  memory.  These  girls  are  neg- 
lecting to  study  the  things  that  will  prepare 
them  for  life.  Not  life,  but  the  college  seems 
their  goal.  In  college  the  girl  studies  more 
thoughtfully,  but  she  is  taught  to  give  little  at- 
tention to  the  things  of  real  importance  to  her. 
The  educating  process  to  which  the  modem 
college  girl  is  subjected  is  not  so  much  directed 
to  make  her  efficient,  observant,  original,  re- 
sourceful, self-reliant,  and  thoughtful,  as  it  is 
to  make  others  think  that  she  is.  And  while  she 
is  learning  the  merits  of  "  Paradise  Lost,"  the 
intrigues  of  the  English  kings,  the  names  of  the 
several  members  of  the  family  of  Stuart,  the 
ramifications  of  the  Greek  verbs,  the  distinc- 
tions between  the  Elizabethan  and  the  Lake 
School  of  poetry,  and  the  psychology  of  im- 
pulses, often  the  roses  of  her  cheeks  are  per- 
ishing and  her  eyes  are  taking  on  the  dreamy, 
far-away  look  of  neurotic  culture. 

Herbert  Spencer  wisely  suggested  that 
should  we  suddenly  become  an  extinct  race,  and 
should  some  future  investigator  find  our  school- 
books,  he  would  think  that  he  had  discovered  a 

129 


MEDICAL    SOCIOLOGY 

race  of  celibates  who  were  interested  in  every- 
thing but  their  own  lives,  happiness,  and  per- 
petuation. The  fact  that  between  forty  and 
fifty  per  cent  of  the  women  admitted  to  the 
hospitals  for  the  insane  in  our  Eastern  States 
belong  to  the  class  which  is  spoken  of  as  "  well 
educated,"  cannot  in  itself  be  taken  as  a  re- 
flection upon  the  work  of  the  schools;  but  it 
does  indicate  that  something  is  wrong  with 
their  manner  of  life  to  bring  them  to  this  un- 
fortunate state;  and  while  we  cannot  say  that 
stress  of  study  is  an  etiological  factor,  we  can 
say  that  their  education  should  have  been  more 
in  the  lines  of  helping  them  to  a  state  of  har- 
mony with  their  environment,  for  want  of  which 
they  have  become  deranged,  and  that  they  have 
frittered  away  precious  study  days  in  chasing 
the  silly  baubles  of  classic  culture. 

If  after  leaving  school  young  women  indulge 
in  practices  which  are  injurious  to  health,  and 
therefore  to  happiness,  it  is  quite  evident  that 
they  have  not  learned  the  best  things.  The  ap- 
preciation of  the  best  things  in  life  is  happily 
growing ;  but  imconscionably  slowly.  The  study 
of  expurgated  physiology,  a  few  lectures  on  hy- 
giene— how  to  ventilate  a  room,  the  harm  of 
tight  lacing,  the  value  of  sleep,  the  importance 

130 


THE    SOCIOLOGY    OP    HEALTH 

of  discretion  in  diet,  and  kindred  subjects — will 
not  make  schoolgirls  healthy.  Self-preserva- 
tion and  perpetuation  is  a  bigger  subject  than 
primary  hygiene.  It  involves  all  of  the  func- 
tions of  the  mind  as  well  as  the  body.  It  in- 
volves all  of  the  day  of  work  and  play  and  sleep. 
It  is  the  most  important  thing  for  young  women 
to  study.  But  in  our  schools  and  colleges  it  is 
as  yet  imperfectly  grasped.  What  is  the  most 
important  function  of  a  woman?  Surely  it  is 
to  be  a  wife  and  mother.  What  does  the  school 
or  college  teach  her  that  prepares  her  for  these 
functions?  But  little.  To  most  so-called  cul- 
tivated girls  wifehood  and  motherhood  are  sur- 
rounded by  clouds  of  sentiment  and  mystery. 
But  the  day  comes  when  they  resolve  them- 
selves into  stem  realities.  The  households  are 
few  in  which  the  inadequacies  of  the  wife  and 
mother  might  not  have  been  remedied  by  previ- 
ous education.  Few  are  the  daughters  who  can 
teach  their  mothers  anything  of  domestic  econ- 
omy, compared  with  the  many  who  excel  their 
mothers  in  knowledge  of  the  doings  of  Henry 
VIII. 

When  we  begin  to  educate  young  women  in 
the  vital  things  of  life  many  of  the  difficult  so- 
cial problems  will  be  answered,  and  we  shall  not 

131 


MEDICAL    SOCIOLOGY 

find  so  much  that  is  pertinent  in  the  questions, 
Wliat  shall  we  do  with  our  girls'?  Why  do 
American  marriages  fail?  Why  do  American 
mothers  fail? 

It  is  a  fact  that  in  a  large  number  of  our 
colleges,  study  of  the  Bible  is  compulsory,  but 
the  study  of  biology  and  the  other  natural  sci- 
ences is  optional.  Is  it  to  be  wondered  at  that 
the  great  cause  of  sexual  sin  is  found  to  be  in 
defective  education,  and  that  the  most  effective 
remedy  is  discovered  to  be  the  simple  teaching 
of  facts? 

It  is  actually  true  that  girls  in  our  schools  lis- 
ten to  instructors  prate  of  the  infinite  when 
their  grasp  of  the  finite  is  so  meager  that  if 
they  were  cast  away  on  a  desert  island  they 
would  perish  of  hunger  and  thirst  in  the  midst 
of  plenty.  There  is  much  that  answers  to  the 
name  of  education,  which,  instead  of  preparing 
young  women  for  life,  is  contributing  to  their 
undoing.  The  one  line  in  which  they  are  least 
learned  is  that  of  the  natural  sciences,  which 
deal  with  the  things  that  surround  us  and  which 
are  known.  The  study  of  the  natural  sciences 
is  the  most  profitable  and  cultivating.  It  helps 
the  mind  and  the  body;  and  so  long  as  it  con- 
tinues to  be  slighted,  young  women  will  lack  sal- 

132 


THE    SOCIOLOGY    OF    HEALTH 

iitary  education.  It  is  the  one  line  of  study  that 
will  save  their  health  and  preserve  them  from 
the  pitfalls  of  mysticism  and  the  cults  of  men- 
tal obliquity.  Next  to  this  in  importance  is  the 
study  of  the  domestic  arts  and  sciences — the 
homely  household  things  that  contribute  to  the 
rounding  of  a  wife  and  mother.  Along  with 
these  should  go  training  in  accuracy  and  origi- 
nality, observation  and  thoughtfulness. 


XV 

PHYSICAL   FITNESS   AT   THE   THKOTTLE 

A  N  important  matter  which  might  wisely 
ZJL  be  under  medical  supervision  is  that 
^  .^  of  the  physical  fitness  of  persons  en- 
gaged in  occupations  in  which  many  lives 
depend  upon  the  good  physical  condition  of 
an  individual.  The  Government,  for  exam- 
ple, supervises  the  traffic  rates  and  the  finances 
of  railroads,  but  takes  little  cognizance  of  the 
lives  of  the  people  who  travel  on  them.  It 
would  seem  that  money  is  more  important  than 
human  lives.  The  railroads  give  some  atten- 
tion to  the  matter,  but  neither  in  a  scientific  or 
disinterested  way:  they  take  the  precautions 
which  give  a  money  value  return. 

The  engineer  of  a  passenger  train  fell  un- 
conscious at  his  post  and  his  train  collided  with 
a  switch  engine  with  disastrous  results.  An- 
other engineer  was  overcome  with  heat,  pre- 
sumably, and  fell  unconscious  at  the  throttle, 
the  fireman  discovering  the  accident  in  time  to 

134 


THE    SOCIOLOGY   OF   HEALTH 

stop  the  train.  The  same  week  an  engineer 
on  a  freight  train,  after  convalescence  from 
a  sickness,  became  suddenly  insane,  and  ran 
his  train  at  a  high  speed  to  escape  an  imag- 
inary evil  pursuer,  until  he  was  overpowered 
by  the  fireman  and  a  brakeman.  These  three 
instances  occurred  all  in  one  section  of  the 
country,  and  all  within  a  period  of  three 
weeks. 

It  is  well  known  that  in  many  of  the  frightful 
railway  wrecks,  in  which  many  lives  are  sacri- 
ficed, the  accident  has  been  due  to  the  physical 
disability  of  some  important  person.  The  fail- 
ure to  set  a  switch,  to  recognize  the  color  of  a 
light,  or  to  fail  in  some  other  act  on  account  of 
physical  defect  has  been  responsible.  This  is 
too  important  a  matter  to  be  left  to  the  cor- 
porations, which  have  only  a  financial  interest : 
it  should  be  under  governmental  control.  A 
railroad  is  violating  a  law  if  it  is  carrying 
freight  for  one  party  for  a  cent  or  two  less  than 
for  another,  but  it  is  violating  no  law  if  a  pa- 
retic engineer  is  rushing  a  train  load  of  people 
to  destruction. 

The  same  is  true  of  all  passenger-carrying 
enterprises.  The  physical  fitness  of  officers  of 
steamboats  should  be  supervised  by  the  state, 

135 


MEDICAL    SOCIOLOGY 

not  alone  by  the  corporations.  The  eyes  of 
motormen  are  tested  in  a  perfunctory  sort 
of  way,  but  the  motorman  may  have  nephri- 
tis or  diabetes  or  arteriosclerosis  and  drop 
down  at  a  critical  time.  It  is  a  fact  that  in 
one  of  our  large  cities  these  positions  are 
being  taken  by  men  who  have  been  found 
physically  defective  for  the  police  and  fire  de- 
partments. 

The  automobile  rushes  through  the  streets 
and  country  in  the  hands  of  anyone  who  puts 
himself  to  the  task.  The  number  of  accidents 
is  appalling.  The  driver  may  be  half  blind, 
deaf,  or  paretic — there  is  no  restriction.  The 
large  number  of  fatalities  are  all  in  the  day's 
work,  so  long  as  we  do  not  know  the  parties  in- 
volved ;  but  still  we  may  be  the  next  victims,  and 
then  it  becomes  a  different  matter.  No  person 
who  has  not  been  subjected  to  a  physical  ex- 
amination and  determined  physically  fit  and 
free  from  disease  which  does  or  might  suddenly 
incapacitate  him  should  be  permitted  to  run  an 
automobile  faster  than  four  miles  an  hour  with- 
in the  town  limits.  A  medical  examination 
should  be  necessary  for  a  license,  and  the  li- 
cense should  be  good  for  one  year.  This  need 
not  be  burdensome  or  expensive,  and  it  would 

136 


THE    SOCIOLOGY    OF    HEALTH 

surely  be  for  the  public  good.  The  antipater- 
nalist  might  object  to  such  an  ordinance,  but 
after  he  is  run  into  by  a  cross-eyed  paretic  he 
will  be  convinced  of  its  value,  if  he  survive  the 
experience. 


XVI 

THE   ACCIDENTS   OF   SUMMER 

THE  newspapers  and  the  medical  press 
are  prone  to  call  attention  to  the  "  acci- 
dents of  summer,"  and  it  is  not  to  be 
gainsaid  that  an  appalling  nnmber  of  misfor- 
tunes and  fatalities  mark  the  summer  holidays. 
In  the  cities,  each  Sunday  or  holiday  has  its 
calamities ;  and  the  country  and  seashore  every 
day  report  disasters  which  have  overtaken  the 
seekers  after  summer  rest  and  recreation. 
These  accidents  and  deaths  are  particularly 
pitiful,  and  even  dramatic,  because  they  occur 
in  the  midst  of  merrymaking  and  happiness, 
and  not  in  the  presence  of  grim  and  dangerous 
occupations.  Many  reasons  have  been  assigned 
in  a  general  way  for  these  misfortunes,  but  all 
have  been  subsidiary.  I  have  never  seen  the 
real  reason  assigned.  Possibly,  because  it  is 
so  simple,  it  has  been  overlooked.  Briefly,  the 
explanation  is  to  be  found  in  the  tendency  of 
persons   engaged   in   strenuous   business   life, 

138 


THE    SOCIOLOGY   OF   HEALTH 

when  the  opportunity  for  a  short  vacation  pre- 
sents itself,  to  seek  some  diversion  which  is 
totally  different  from  their  daily  occupation, 
and  to  apply  the  same  strenuous  efforts  to 
"  having  a  good  time  "  as  they  apply  to  their 
everyday  vocation.  This  can  never  be  done 
with  safety. 

A  mill  hand  works  for  fifty  weeks  with  his 
dangerous  machinery  and  is  not  hurt,  because 
he  is  familiar  with  it;  but  when  he  steps  in  a 
catboat  and  gets  mixed  up  with  the  tides  and 
weather,  trying  to  have  enough  fun  in  two 
weeks  to  last  him  the  rest  of  the  year,  David 
Jones  is  waiting  for  him.  And,  on  the  other 
hand,  the  fellow  who  sails  a  boat  all  the  year 
had  better  keep  his  fingers  out  of  the  wheels  of 
the  mill. 

For  eleven  months  the  pale-faced  bank  clerk 
has  grown  soft  and  flabby  with  his  eye  on  his 
ledger  page.  He  has  had  his  cocktail  before 
dinner,  and  at  night  over  his  pipe  has  sat  about 
the  grill-room  camp  fire  and  dilated  upon  the 
merits  of  smokeless  powder,  while  the  hands  of 
the  tall  clock  in  the  comer  have  become  scarcely 
visible  through  the  thickening  smoke.  His  oc- 
ulist adds  a  diopter  or  two  to  his  glasses;  and 
in  the  late  fall  he  packs  his  paraphernalia  and 

139 


MEDICAL   SOCIOLOGY 

plunges  into  the  woods.  He  tries  to  make  him- 
self look  like  a  half-breed,  and  thinks  that  he 
does;  but  his  guide  smiles  a  deep  smile  that 
shows  not  on  his  placid  face.  Now,  if  you  look 
any  more  like  a  deer  than  a  well  curb  does,  my 
advice  to  you  is  to  keep  out  of  the  banker's 
range,  or  there  may  be  another  of  these  "  ac- 
cidents of  the  summer."  And  the  native  woods- 
man would  make  just  as  bad  a  mess  at  figur- 
ing discounts. 

The  prince  of  the  ballroom  and  the  after- 
noon tea  never  really  has  an  opportunity  to  dis- 
play his  manliness  until  he  gets  into  his  bath- 
ing suit.  The  undertow  and  a  breaker  or  two 
start  in  to  eat  him  up,  and  they  get  away  with 
him  so  far  that  Sylvester's  method,  for  three 
steady  hours,  leaves  him  cold  and  limp.  And 
the  tough  old  life  guard  would  cut  a  sorry  fig- 
ure in  the  cotillion. 

The  mistake  made  by  our  sunomer  vacationist 
is  to  plunge  into  vacation  with  the  confidence 
of  vocation ;  and  in  these  strenuous  days  there 
is  too  wide  a  distance  for  safety  between  the 
two. 

The  cheap  seaside  resorts  vie  with  one  an- 
other to  furnish  their  patrons  with  new  sensa- 
tions; and  the  frequenters  of  these  places  get 

140 


THE    SOCIOLOGY   OF   HEALTH 

so  much  for  a  small  outlay  of  money  that  they 
find  the  attractions  irresistible.  All  sorts  of 
death-inviting  devices  shoot  people  like  cata- 
pults down  grades,  up  grades,  and  through  the 
air.  The  ingenuity  that  has  been  expended  in 
contriving  machines  to  give  people,  in  the  bloom 
of  health,  an  opportunity  of  coming  up  to  the 
death  line,  almost  to  the  crossing  place,  feeling 
the  cool  breath  of  eternity,  and  then  receding 
in  the  exhilaration  of  safety,  would  solve  many 
a  human  problem  if  applied  to  that  end.  Un- 
fortunately, the  insanity  of  amusements  of 
our  seaside  resorts  does  not  give  recreation. 
Most  of  the  patrons  of  Coney  Island  find 
themselves  worse  off  for  it  on  Monday  morn- 
ing. It  involves  more  nervous  strain  and  ex- 
citement than  exists  in  their  everyday  work, 
and  many  more  dangers,  as  experience  has 
shown. 

Thousands  of  employees  work  hard  all  the 
year,  and  have  a  vacation  of  two  weeks  in  July 
or  August.  This  vacation  is  an  event,  and 
well  it  should  be,  for  their  labors  have  earned 
them  two  weeks  many  times  over.  It  is  pre- 
pared for  and  thought  about,  and  a  good  time 
must  be  had  at  any  cost.  The  "  good  time  "  too 
often  consists  in  endeavoring  to  crowd  into  that 

141 


MEDICAL   SOCIOLOGY 

short  space  a  succession  of  events  which  should 
have  been  distributed  more  equably  through  the 
year.  The  vacationist  often  works  more  stren- 
uously at  having  a  good  time  than  he  does  at 
earning  his  livelihood. 

All  of  these  conditions  cause  an  approach  to 
the  danger  line  in  vacation  time ;  and  behind  it 
all  lies  the  strenuous  life.  "While  the  habits  of 
the  people  and  our  social  and  economic  condi- 
tions are  slow  to  change,  it  is  always  to  be  hoped 
that  society  may  yet  organize  itself  so  that  its 
affairs  may  move  along  more  smoothly.  The 
labors  of  the  men  and  women  who  toil  should 
so  be  regulated  that  recreation  is  intermingled 
with  work  in  wholesome  proportions.  No  coun- 
try or  people  in  the  world  are  so  deficient  in  the 
practice  of  sensibly  interspersing  labor  with 
play  as  the  Americans.  The  average  American, 
who  is  fighting  his  way  to  business  success,  does 
not  know  how  to  play  or  to  take  recreation.  The 
people  of  the  Old  World  are  so  superior  to  us 
in  this  that  we  might  wisely  sit  at  their  feet  and 
learn  how  to  play  and  how  to  relax.  The  real 
spirit  of  the  Landpartie,  the  outing  of  the  Ger- 
mans, or  of  the  jour  de  fete  of  the  French  has 
never  been  developed  on  American  soil.  We 
lack  appreciation  of  restful  pleasures. 

142 


THE    SOCIOLOGY   OF   HEALTH 

There  is  little  that  the  law  can  do.  It  is  not 
a  matter  of  throwing  more  safeguards  about 
the  people,  as  is  suggested.  The  defect  is  mani- 
festly a  fundamental  one,  and  lies  in  our  socio- 
logic  economic  conditions. 


11 


XVII 

LIFE-INSURANCE    INTERESTS 

WHILE  we  look  askance  at  some  of 
the  methods  of  the  life-insurance 
companies  and,  indeed,  discover 
that  many  engage  in  practices  which  are  in- 
compatible with  high  ethical  ideals,  we  can- 
not lose  sight  of  the  immense  service  which 
these  organizations  render  to  the  public.  Life 
insurance  is  a  well-recognized  and  approved 
business,  without  any  more  philanthropy  in 
it  than  any  other  business  has ;  and  we  should 
be  glad  that  as  a  business  it  is  a  success. 
It  is  not  upon  the  fact  that  it  provides  a 
means  by  which  we  can  insure  our  families 
against  the  contingencies  of  the  future  that  I 
desire  to  comment,  but  it  is  its  indirect  service 
to  the  whole  people  in  calling  attention  to  the 
value  of  good  health  that  should  not  be  lost 
sight  of. 

The  life-insurance  companies  are  doing  much 
to  interest  men  in  their  own  lives  and  in  the 

144 


THE    SOCIOLOGY   OF   HEALTH 

lives  of  their  families ;  and  anything  which  ac- 
complishes that  is  of  salutary  influence.  They 
are  a  powerful  and  practical  agency  for  remind- 
ing people  of  matters  of  health  and  longevity. 
Men  with  bad  habits  and  excesses  are  refused 
insurance,  and  such  refusals  have  a  good  edu- 
cational effect.  Plant  in  a  man's  heart  a  deep 
regret  that  he  has  lived  unwisely  and  he  be- 
comes a  torchbearer,  often  unwittingly,  to 
warn  others  away  from  his  unwisdom.  The  in- 
surance companies  also  desire  as  examiners  the 
competent  men  of  the  community,  the  effect  of 
this  being  that  wholesome  competition  and  ex- 
amination ensue. 

There  still  remains  for  these  organizations  to 
combine  in  a  concerted  action  to  secure  better 
general  health  conditions.  Just  as  the  fire-in- 
surance companies  combine  in  the  support  of 
the  salvage  corps,  and  in  watchfulness  over  the 
efficiency  of  the  municipal  fire  departments,  so 
the  life-insurance  interests  have  an  opportunity 
as  a  clear  business  matter  to  join  hands  with 
the  medical  profession  and  sanitarians  in  the 
great  movements  which  are  in  progress  for  the 
improvement  of  the  public  health.  If  in  in- 
hibiting the  development  of  epidemics  the  medi- 
cal   profession    is    taking   bread    from    itself, 

145 


MEDICAL   SOCIOLOGY 

this  could  not  be  said  of  the  life-insurance 
interests.  They  can,  as  a  matter  of  plain  busi- 
ness policy,  give  every  aid  to  medicine  in  its 
philanthropic  efforts.  The  life-insurance  com- 
panies could  wisely  take  the  same  interest  and 
lend  aid  in  the  work  of  health  departments  as 
the  fire-insurance  companies  do  in  the  work  of 
,fire  departments.  No  single  financial  interest 
should  be  more  deeply  concerned  for  the  public 
health;  and  none  can  with  greater  pecuniary 
profit  engage  in  the  movement  to  secure  the  es- 
tablishment of  a  national  department  of  health. 


XVIII 

UNHYGIENIC   IMMUNITY 

IMMUNITY  against  almost  any  condition 
which  threatens  health  may  be  acquired. 
There  are  certain  fundamental  things 
which  general  scientific  opinion  is  agreed  upon. 
It  is  agreed  that  pure  water  and  pure  air  are  bet- 
ter for  the  health  than  impure  water  and  impure 
air ;  and  the  advance  of  civilization  has  resulted 
in  the  general  acceptance  of  these  beliefs.  How- 
ever, an  immunity  against  many  of  the  impuri- 
ties existing  in  air  and  water  may  be  acquired. 
It  is  well  known  that  races  which  live  in  condi- 
tions which  to  us  would  be  squalor,  drinking  and 
eating  dirty  foods,  enjoy  an  immunity  from  the 
dangers  of  filth  and  thrive  under  conditions 
which  would  be  fatal  to  the  more  cleanly  races. 
Intestinal  infections  which  give  the  natives  of 
the  tropics  little  trouble  are  fatal  to  the  Eng- 
lish soldiers.  The  people  of  some  of  the  south- 
em  countries  of  Europe  eat  meat  in  a  state  of 
decay  that  would  prostrate  the  northern  Euro- 

147 


MEDICAL    SOCIOLOGY 

pean.  One  can  cultivate  an  immunity  for  pto- 
maines as  well  as  for  alcohol  and  tobacco. 

What  is  true  of  insults  to  the  gastrointestinal 
tract  is  also  true  of  the  respiratory  tract.  The 
Eskimos  in  the  winter  shut  themselves  in  and 
breathe  over  and  over  again  the  vitiated  air 
from  their  own  lungs,  living  practically  in  a 
state  of  hibernation;  yet  this  practice  has  ex- 
isted so  long  that  they  have  acquired  an  immu- 
nity to  their  own  bad  air;  but  transported  to 
temperate  climates  and  surrounded  by  condi- 
tions which  seem  more  hygienic,  they  are  prone 
to  contract  consumption  and  die.  It  is  reported 
from  Panama  that  the  negroes  of  the  West  In- 
dies are  suffering  a  high  degree  of  mortality, 
although  they  are  compelled  to  live  under  ap- 
parently good  conditions.  These  negroes  in 
their  native  state  live  in  filth  and  bad  air,  yet 
they  perish  under  the  conditions  which,  theo- 
retically, should  be  favorable. 

On  the  other  side  we  have  a  still  different 
picture.  It  is  true  that  the  strongest  and 
most  healthy  persons  often  are  made  ill  by 
violations  of  hygiene  which  the  less  robust 
endure  without  complaint.  I  know  of  persons 
who  live  according  to  the  most  advanced  knowl- 
edge  of   hygiene,    sleeping    in   the    open   air, 

148 


THE    SOCIOLOGY   OF   HEALTH 

and  living  out  of  doors  practically  day  and 
night,  who  suffer  from  oppression  of  breath- 
ing, headache,  and  even  nausea,  in  the  vitiated 
air  of  a  theater  or  church,  while  the  weakly 
shopkeeper  or  clerk,  who  spends  most  of  his 
time  in  a  vitiated  atmosphere,  is  comfortable 
and  blithe. 

Thus,  there  are  penalties  for  the  healthy  as 
well  as  for  the  sickly.  The  human  organism 
suffers  temporarily  from  any  sudden  change 
into  new  conditions  from  old  conditions  under 
which  it  has  thrived,  whether  it  be  for  better 
or  for  worse ;  and  it  is  capable  of  developing  an 
immunity  to  poisonous  materials,  either  in- 
haled or  ingested,  provided  that  the  immuniz- 
ing process  is  approached  gradually.  This 
power  to  become  immune  to  the  constant  as- 
saults of  poisons  is  a  part  of  the  great  organic 
law  which  has  enabled  animal  life  to  endure, 
and  which  has  contributed  to  the  differentiation 
of  species. 


XIX 


FRESH   AIR 


FEESH  air,  in  distinction  from  air  that 
is  not  fresli,  is  simply  the  ordinary  out- 
of-door  air  in  contrast  with  the  ordi- 
nary indoor  air.  The  latter  contains  less  mois- 
ture; it  has  had  oxygen  removed  by  animal 
respiration  and  by  combustion;  it  has  had 
added  to  it  the  products  of  these  chemical 
changes;  and  there  are  presumably  other 
changes  the  nature  of  which  we  do  not  know. 
Some  day  the  chemist  will  be  able  to  define  the 
exact  differences  in  the  composition  and  struc- 
ture of  the  two  airs.  At  present  we  do  not  know 
much  about  it  from  the  chemical  and  physical 
standpoint;  but  from  the  practical  and  clinical 
standpoint  much  has  been  learned. 

The  greatest  appreciation  of  the  value  of 
fresh  air  came  through  the  study  of  consump- 
tion. It  was  observed  that  for  a  person  who 
had  contracted  this  disease  to  live  as  other 
people  lived  meant  death.     The  consumptive 

150 


THE    SOCIOLOGY    OF   HEALTH 

does  not  do  well  when  he  continues  in  the  same 
habits  as  are  followed  by  all  of  the  candidates 
for  consumption.  The  observation  that  people 
with  this  disease  recovered  if  they  lived  in 
the  fresh  air  and  died  if  they  lived  in  the  or- 
dinary indoor  air,  has  been  one  of  the  most  im- 
portant discoveries  that  man  has  made.  Its 
importance  has  not  yet  been  realized;  but  it  is 
destined  to  be  of  great  human  service. 

The  most  important  food  that  we  consume  is 
air;  the  next  in  importance  is  water,  and  the 
next  is  the  product  of  the  grocery  shop.  Man 
can  live  without  the  latter  for  three  weeks; 
without  the  next  for  one  week ;  and  without  the 
former  for  three  minutes.  Air  is  the  cheapest, 
the  most  abundant,  and  the  most  essential.  We 
have  given  much  attention  to  pure  groceries; 
and  we  should  be  loath  to  consume  over  again 
what  some  one  else  has  ejected.  We  have  more 
recently  awakened  to  the  importance  of  pure 
water;  and  the  harm  of  ingesting  water  which 
some  one  else  has  used  is  well  understood.  But 
there  is  as  yet  inadequate  consideration  given 
to  the  prevalent  practice  of  taking  into  our  own 
lungs  the  sewage  of  other  lungs.  The  consump- 
tive has  learned  that  it  is  not  good  for  him ;  the 
next  person  who  should  learn  it  is  the  noncon- 

151 


MEDICAL    SOCIOLOGY 

sumptive.  It  was  not  many  years  ago  that  only 
the  sickly  and  delicate  were  particular  about 
the  water  they  drank.  They  noticed  that  sick- 
ness developed  if  they  took  water  that  was  not 
pure.  The  robust  were  ashamed  to  complain  of 
dirty  water.  They  thought  their  constitution 
would  stand  most  anything.  But  it  was  learned 
that  dirty  water  contained  materials  which  had 
the  power  of  weakening  the  strong.  Now  every- 
body demands  clean  water.  We  have  learned 
many  of  our  best  lessons  from  the  sick.  We 
first  paid  heed  to  their  food;  we  washed  them 
and  kept  them  clean.  Then  it  became  the  cus- 
tom for  the  well  to  pay  attention  to  their  own 
food,  and  for  the  well  to  wash  and  keep  clean 
before  they  became  sick.  The  demand  for  fresh 
air  is  going  to  grow  up  in  the  same  way. 

A  great  many  diseases  have  been  found  to  be 
caused  or  encouraged  by  improper  food  and  un- 
clean water.  It  is  difficult  to  determine  which 
was  the  first.  It  is  a  coincidence  that  consump- 
tion was  the  first  to  be  identified  as  being  asso- 
ciated with  bad  air.  The  rest  of  man's  mala- 
dies will  follow.  Already  tuberculosis  of  the 
bones  and  joints  in  children  is  being  treated 
in  the  open  air  with  beneficial  results  that 
promise  even  to  surpass  those  secured  in  con- 

152 


THE    SOCIOLOGY    OF    HEALTH 

sumption.  Hundreds  of  these  children  are  be- 
ing cured  because  the  hospitals  are  taking  them 
out  of  the  wards  and  putting  them  on  the  roofs 
and  balconies.  Pneumonia  patients  are  receiv- 
ing the  same  beneficent  consideration;  and  the 
mortality  of  the  disease  is  being  lowered.  The 
mortality  in  the  treatment  of  typhoid  fever  was 
never  so  low  as  it  was  among  the  soldiers  who 
lay  sick  in  tents  during  the  Spanish- American 
War.  The  insane  and  neurotic  recover  in  the 
open  air,  when  they  used  to  perish  in  their 
cells.  The  modern  sanitarium  in  a  beautiful 
country  which  invites  the  sick  out  of  doors  is 
bound  to  give  results,  because  the  patients  are 
brought  from  the  indoors.  Fresh  air  is  not  only 
important  for  these  classes  of  unfortunates,  but 
it  remains  to  be  applied  to  all  illnesses,  surgical 
as  well  as  medical.  Then  it  will  be  observed 
that  it  is  no  treatment  at  all. 

Properly  speaking,  the  application  of  fresh 
air  to  tuberculosis  of  the  lungs  is  not  a  treat- 
ment— ^it  is  simply  giving  the  lungs  what  they 
are  intended  by  nature  to  have.  Tuberculosis 
infection  becomes  implanted  and  grows  in  lungs 
which  are  fed  upon  impure  air.  Making  the 
patient  live  out  of  doors  is  a  return  to  the  nat- 
ural and  normal  requirements  of  the  respira- 

153 


MEDICAL    SOCIOLOGY 

tory  apparatus.  When  one  has  become  ill  from 
impure  food,  he  is  cured  by  giving  healthful 
food.  When  one  is  made  ill  by  breathing  illu- 
minating gas,  the, first  step  in  the  treatment  is 
to  give  pure  air.  The  first  essential  in  the 
treatment  of  a  consumptive  is  to  take  him  out 
of  the  house;  just  the  same  as  the  first  essen- 
tial in  the  treatment  of  a  drowning  man  is  to 
take  him  out  of  the  water.  When  primitive 
peoples  become  sufficiently  "  civilized "  to  live 
in  houses,  the  same  misfortune  overtakes  them 
that  overtakes  the  simian  removed  from  his 
jungle  to  the  museum:  they  contract  pulmo- 
nary disease. 

When  a  fisherman  on  Cape  Cod  contracts 
pneumonia,  they  often  put  him  in  a  little  bed- 
room which  is  nearly  as  air-tight  as  though  it 
had  been  calked.  He  has  been  used  to  wind  and 
weather  all  his  life,  and  his  wife  often  harbors 
the  notion  that  that  is  what  brought  on  his 
pneumonia.  The  blinds  are  closed;  and  in  the 
sick  room  you  will  find  an  old  nurse  fanning  the 
patient,  and  a  veritable  young  stove  of  a  kero- 
sene lamp  eating  up  the  oxygen. 

The  mortality  from  pneumonia  among  these 
men  is  extremely  high.  When  the  doctor  ar- 
rives (he  has  driven  five  or  ten  miles  through 

154 


THE    SOCIOLOGY   OF   HEALTH 

a  wind  that  lias  nearly  taken  his  breath  away) 
he  goes  in  the  house,  and  is  thankful  enough 
to  find  a  good  shelter.  It  is  the  most  comfort- 
able place  he  has  been  in  since  he  left  the  last 
house,  an  hour  before.  If  he  should  suggest 
more  air  for  the  patient,  his  orders  would  not 
be  carried  out.  This  is  what  happens  to  the  old 
fisherman:  he  dies. 

It  is  curious  enough  that  a  dry-goods  clerk 
would  stand  a  better  chance  of  recovery  under 
these  circumstances  than  the  fisherman,  for 
nature  bestows  a  certain  measure  of  immunity 
against  bad  air  upon  those  who  habitually  live 
in  it.  By  j)ractice  the  diver  can  remain  longer 
and  longer  under  water.  A  man  may  accustom 
himself,  at  the  expense  of  his  health,  to  get 
along  with  less  oxygen  and  more  carbon  diox- 
ide. This  habituation  stands  him  in  good  stead 
when  he  has  to  be  shut  up  in  a  room  with  a 
quarter  or  a  half  of  his  oxygen-absorbing  ap- 
paratus put  out  of  commission.  But  our  fish- 
erman, whose  bellows  has  been  blown  up  with 
wind  from  every  point  of  the  compass,  has  not 
had  the  immunity  to  bad  air  which  our  dry- 
goods  clerk  has  enjoyed,  and  when  his  oxygen 
is  shut  off  he  dies  like  a  rat  under  a  bell- jar. 

Breathing  fresh  air  improves  the  health  and 
155 


MEDICAL   SOCIOLOGY 

resistance  of  anyone  who  is  habitually  without 
it,  and  that  means  pretty  nearly  everybody. 
Fresh  air  increases  the  resistance  of  those  with 
consumption.  It  also  does  the  same  for  those 
without  consumption  and  for  those  with  other 
diseases,  chief  among  which  is  that  great  symp- 
tom complex  from  which  most  indoor  dwellers 
suffer  and  which,  for  want  of  a  better  name, 
we  may  call  stuffiness,  due  to  the  breathing  of 
vitiated  air.  To  advise  continuous  fresh  air  for 
the  consumptive  alone  is  hardly  fair  to  those 
who  are  still  doing  their  full  day's  work  without 
complaint — they  need  it,  too.  Let  us  not  neglect 
them  while  they  are  yet  not  consumptives. 

Out  of  this  study  of  consumption  is  destined 
to  develop,  first  the  appreciation  of  the  value 
of  fresh  air  to  the  sick,  and  then  to  the  well. 
And  when  the  well  grasp  the  significance  of 
this,  humanity  will  have  taken  one  of  its  longest 
strides  forward  upon  the  road  of  hygiene. 
This  is  but  one  of  the  benefits  that  consump- 
tion confers.  The  gaunt  form  of  the  great 
white  plague  stalks  at  the  head  of  the  proces- 
sion, and  leads  the  way  to  the  open  air. 

Physicians  who  have  most  carefully  studied 
the  nature  of  the  ordinary  cold  tell  us  that  the 
people  who  live  close  to  nature  are  exempt.    It 

156 


THE   SOCIOLOGY   OF  HEALTH 

is  the  denizen  of  the  city,  surrounded  with  the 
luxuries,  who  suffers  the  most.  Vitiated  air 
and  the  contrivances  that  he  buys  to  keep  away 
the  cold  are  responsible  for  his  colds.  The 
woodsman,  who  lives  and  works  in  the  open 
and  sleeps  in  a  freezing  hut,  enjoys  immunity. 

The  sufferers  from  colds  are  those  who  spend 
a  large  part  of  the  winter  time  in  an  unnatural 
atmosphere.  The  air  in  offices,  stores,  theaters, 
factories,  and  dwellings  in  this  climate  is  bad. 
Its  temperature  is  usually  higher  than  is  con- 
sistent with  good  health ;  each  occupant  inhales 
the  materials  that  have  come  out  of  some  one 
else's  lungs ;  and  the  percentage  of  moisture  in 
the  air  is  below  the  normal.  These  are  due  to 
the  defects  of  the  modem  heating  appliances. 
It  is  a  long  step  backward,  so  far  as  healthful- 
ness  goes,  from  the  fireplace  of  our  ancestors 
to  the  steam-heated  radiator. 

Of  all  the  iniquitous  machinery  that  has  ever 
been  contrived  to  destroy  the  weaklings  and 
emasculate  the  strong,  this  radiator  stands  pre- 
eminent. Here  is  a  thing  which  can  be  put  in  a 
room,  and  the  more  tightly  the  room  is  sealed 
against  the  inlet  and  egress  of  air  the  more  ef- 
fective it  is  and  the  more  it  is  vaunted  as  a  suc- 
cessful heater.     The  furnace,  which  was  cast 

157 


MEDICAL   SOCIOLOGY 

out  to  give  place  to  this  thing,  is  eminently 
more  rational.  Every  cubic  foot  of  air  from 
the  furnace  that  enters  a  room  displaces  a  cubic 
foot ;  it  will  not  work  unless  there  is  ventilation. 
And  the  old-fashioned  stove  and  the  fireplace 
all  demand  ventilation;  but  the  radiator  works 
best  without  it.  The  ideal  heating  system  to 
supply  fresh  air  is  that  by  which  outdoor  air 
is  conducted  directly  into  closed  boxes  in  the 
basement  containing  steam  radiators  and  pans 
exposing  a  large  surface  of  water  for  evapora- 
tion. From  these  boxes  the  fresh  air,  heated 
by  contact  with  the  radiators  and  carrying  the 
moisture  evaporated  from  the  pans  of  water, 
is  then  conducted  through  large  hot-air  pipes 
and  delivered  to  the  rooms  through  registers. 

The  intolerable  heating  iniquities,  not  to  be 
considered,  are  the  gas  stove  and  the  oil  stove, 
which  when  inclosed  in  a  room  consume  the 
oxygen  and  throw  out  in  its  place  their  noxious 
products. 

Most  modern  heating  apparatuses,  we  are 
shown,  possess  the  disadvantage  that  they  dry 
the  air.  Examination  of  the  air  of  rooms  in 
the  winter  reveals  from  five  to  thirty  per  cent 
less  moisture  than  is  present  in  the  normal  out- 
door air.    Our  indoors  winter  population  lives 

158 


THE    SOCIOLOGY    OF   HEALTH 

in  an  atmosphere  so  far  below  the  point  of  sat- 
uration that  evaporation  is  constantly  and 
more  rapidly  than  normal  taking  place  from  the 
skin  and  respiratory  mucous  membranes.  A  re- 
sult of  this  evaporation  is  a  sensation  of  cool- 
ness. It  is  not  uncommon  to  find  in  an  office  a 
temperature  of  seventy  or  seventy-five  degrees, 
or  even  higher,  and  yet  a  sensation  of  chilliness 
when  the  moisture  is  low ;  whereas  in  a  kitchen, 
with  boiling  pots  on  the  stove,  a  much  lower  tem- 
perature imparts  a  decided  sense  of  warmth  to 
the  skin.  It  has  been  shown  that  persons  breath- 
ing abnormally  dry  warm  air  have  the  vital  re- 
sisting power  of  their  respiratory  mucous  mem- 
branes decidedly  lowered  and  rendered  suscep- 
tible to  the  complex  of  phenomena  designated 
as  cold.  Thus  we  find  in  our  modem  system 
for  preventing  coldness  the  conditions  conduc- 
ing to  colds. 

As  heating  materials  become  more  expensive, 
greater  economy  in  conserving  the  heat  in 
buildings  is  practiced.  This  is  done  by  mini- 
mizing the  amount  of  fresh  air  which  is  allowed 
the  tenants.  Colds  are  the  result.  Colds  are 
prevalent  in  winter,  the  best  authorities  inform 
us,  not  directly  because  of  the  cold,  but  because 
that  is  the  season  when  people  shut  themselves 
13  159 


MEDICAL    SOCIOLOGY 

in  and  breathe  bad  air.  Persons  who  have  en- 
joyed pure  air  all  the  summer,  habitually  re- 
verse their  practice  and  give  themselves  pure 
air  in  winter  only  when  they  are  out  of  doors. 
As  a  matter  of  fact,  cold  air  is  better  to  breathe 
than  warm  air,  even  though  equally  pure.  It  is 
more  concentrated.  Every  inhalation  of  cold 
air  gives  one  more  oxygen  than  an  inhalation  of 
warm  air. 

The  lessons  which  we  learn  from  the  consid- 
eration of  these  medical  teachings  are,  that  we 
should  inure  ourselves  to  the  cold  of  winter, 
that  we  should  court  the  fresh  air,  and  that  in 
heating  our  houses  it  should  be  done  by  means 
which  give  ventilation  and  moisture.  Thoreau 
said  that  he  loved  the  cold  when  it  chilled  his 
skin;  he  was  like  an  oak  tree — it  did  him  no 
harm  because  he  was  always  in  the  air,  be  it 
warm  or  cold. 

Gould,  in  discussing  the  seven  deadly  sins  of 
civilization,  classes  the  modem  house  among 
them.  The  modern  house  is  probably  not  so 
guilty  as  the  way  in  which  we  abuse  it.  It  is 
pretty  generally  constructed  so  as  to  protect 
the  inmates  from  the  weather,  but  the  inmates 
have  perverted  it  to  shutting  out  the  benefits  of 
air  and  light  and  to   shutting  themselves  up 

160 


THE    SOCIOLOGY    OF   HEALTH 

with,  the  unwholesome  emanations  of  their 
own  bodies.  The  house  cannot  be  classed  as 
a  great  evil,  but  man's  habits  in  the  house  can. 
Information  upon  this  important  matter  is 
easily  to  be  had.  Let  one  walk  the  streets  at 
night  and  he  will  be  able  to  recognize  the  bed- 
rooms by  noting  which  windows  are  most 
tightly  closed.  In  the  city  whole  blocks  may  be 
observed  in  which  the  bedrooms  are  easily  dis- 
cernible by  closed  sashes,  blinds,  and  shades. 
Sometimes  a  window  will  be  seen  to  be  open  a 
few  inches,  but  this  is  exceptional  even  in 
spring  and  fall  when  the  air  is  not  cold.  An- 
other interesting  study,  this  time  in  psychology, 
may  be  made;  for,  if  the  dwellers  in  these 
rooms  are  questioned,  they  will  declare  that 
"  we  are  great  fresh-air  cranks  at  our  house." 
Bad  air  is  responsible  for  some  remarkable  as- 
saults upon  the  truth.  These  people  are  vic- 
tims simply  of  traditions,  examples,  and  habits 
— all  hard  things  to  overcome. 

One  of  the  points  in  which  there  is  a  gross 
misconception  as  to  the  function  of  the  house 
is  that  it  is  to  hold  air  to  keep  the  body  warm. 
The  tendency  in  the  winter  is  to  treat  the  air  of 
the  house  as  though  its  first  use  were  for  its 
warmth,  when  really  its  first  use  is  for  breath- 

161 


MEDICAL    SOCIOLOGY 

ing.  The  first  concern  should  be  that  the  air  is 
pure;  and  any  warmth  that  is  not  consistent 
with  that  is  not  worth  having.  Clothes  and 
good  skin,  reaction  should  be  relied  upon  for  the 
warmth  of  the  surface  of  the  body.  The  air  is 
for  food,  and  it  is  too  precious  to  be  used  for 
clothing. 

If  we  have  to  work  indoors,  we  can  at  least 
sleep  out  of  doors  during  the  eight  hours  that  are 
not  required  to  be  sacrificed  to  society.  Some 
few  people  who  are  not  sick  do  it  just  for  the 
joy  of  it.  They  like  to  awaken  in  the  morning, 
after  eight  hours  in  the  open,  with  an  appetite 
for  breakfast,  and  feeling  as  though  they  had 
just  returned  from  a  vacation  in  the  country. 
Acres  of  roofs  and  balconies  in  the  cities  are 
going  to  waste.  Some  day  they  will  be  utilized 
and  the  dwellers  in  the  caverns  will  come  forth 
and  sleep  under  the  canopy  of  heaven.  The 
day  will  come  when  outdoor  sleeping  facilities 
will  be  provided  in  every  house  that  is  built, 
just  as  bathing  and  toilet  facilities  are  now  pro- 
vided. But  before  that  day  there  is  much  edu- 
cational work  to  be  done.  Many  superstitions 
and  traditions  are  to  be  overcome.  The  buga- 
boo of  "  night  air  "  is  to  be  disposed  of.  People 
are  to  be  taught  that  that  is  the  only  kind  of 

162 


THE    SOCIOLOGY    OF    HEALTH 

air  there  is  to  breathe  at  night.  The  prob- 
lem of  outdoor  beds  and  awnings  is  simple. 
It  is  difficult  only  in  the  mind  of  the  inex- 
perienced. 

Children  always  excite  our  sympathy  more 
than  adults;  and  naturally,  too,  because  they 
are  not  altogether  free.  They  are  both  benefi- 
ciaries and  victims.  I  confess  that  I  know  but 
few  that  are  not  the  victims  of  bad  air.  Here 
is  a  little  girl  who  presses  her  pale  face  against 
the  pane,  but  is  not  allowed  out  because  it  is 
"  too  cold  "  or  "  too  damp  "  or  because  she  has 
"  a  cold."  She  is  in  the  house  for  one  or  the 
other  of  these  reasons  most  of  the  winter.  In 
the  summer  she  is  out  of  doors,  and  conse- 
quently begins  the  winter  with  fair  health.  She 
sleeps  in  a  bedroom  heated  by  a  radiator.  The 
window  is  open  two  inches  at  the  bottom.  About 
her  crib  is  a  barrier  to  protect  her  from  the 
draughts.  The  air  is  so  close  and  warm  that  she 
sleeps  restlessly.  Diseased  tonsils  and  ade- 
noids have  naturally  developed.  The  question 
is:  Where  is  the  culpability?  And  the  answer 
is :  In  the  education  of  the  parents.  Nor  would 
I  altogether  excuse  the  medical  profession  from 
the  blame.  There  is  yet  much  to  learn  concern- 
ing some  of  these  simples  of  health. 

163 


MEDICAL    SOCIOLOGY 

The  mother  whose  child  perspires  at  night 
and  cannot  be  kept  covered,  and  who  offers  this 
as  the  reason  for  depriving  the  child  of  fresh 
air  when  the  perspiring  and  restlessness  both 
are  due  to  the  withholding  of  fresh  air,  may  be 
regarded  as  an  educated  woman,  but  the  sort 
that  she  possesses  should  really  not  pass  cur- 
rent under  the  holy  name  of  education.  Air  is 
to  breathe,  not  to  wear ;  and  the  mother  who  has 
not  the  ingenuity  to  cover  her  babe  at  night  so 
that  it  may  have  freedom  to  roll  and  still  re- 
main covered,  should  cancel  all  other  engage- 
ments and  roam  the  world  until  she  finds  the 
mother  who  can  teach  her,  and  then  sit  at  her 
feet  and  learn  a  lesson  of  more  significance 
than  anything  that  her  professor  of  English  lit- 
erature ever  taught  her.  I  know  a  simple 
woman,  the  wife  of  a  laborer,  whose  babe  slept 
day  and  night  in  a  clothes  basket  on  the  fire 
escape.  A  big  umbrella  from  a  delivery  truck, 
proclaiming  the  merits  of  a  brand  of  soap,  kept 
off  the  rain  and  snow.  When  the  babe  outgrew 
this  bed,  a  shallow  packing  box  took  its  place, 
protected  on  the  north  by  a  barrier  of  muslin. 
This  is  the  only  really  rugged,  happy  infant  in 
the  apartment.  The  others  get  into  the  fresh 
air  when  some  one  takes  the  trouble  to  dress 

164 


THE    SOCIOLOGY    OF    HEALTH 

them  up  and  pusli  tliem  througli  the  streets  in 
a  carriage,  which  is  not  often,  because  it  in- 
volves too  much  labor  and  the  time  of  an  extra 
adult.  There  are  women  with  pallid  children 
who  are  deeply  concerned  with  "  improving  the 
condition  of  the  poor,"  who  might  with  profit 
learn  from  this  woman  of  simple  culture  much 
for  improving  the  condition  of  the  rich.  One 
of  the  most  inspiring  conditions  with  which  I 
am  familiar  is  that  of  a  family  of  six,  with  chil- 
dren ranging  from  one  to  five  years  of  age,  in 
the  heart  of  a  great  city,  going  to  bed  at  night 
on  the  roof,  in  all  the  seasons  of  the  year.  The 
problem  of  awnings  to  keep  off  the  rain,  snow, 
and  wind  have  been  simply  solved,  but  usually 
the  starry  heaven  is  their  roof.  Some  interest- 
ing facts  attach  to  these  conditions:  The  chil- 
dren in  the  appearance  of  healthfulness  are  so 
different  from  the  other  children  of  the  city 
that  they  look  like  a  different  strange  and 
rugged  race ;  they  eat  simple  foods  and  have  no 
whims  of  daintiness ;  they  would  regard  it  as  a 
punishment  to  be  made  to  sleep  indoors;  they 
know  something  of  the  stars  and  moon  and  have 
a  wider  outlook  upon  the  great  universe  about 
them;  and  their  mother  finds  little  in  common 
with  those  who  speak  of  the  care  of  children  as 

165 


MEDICAL    SOCIOLOGY 

a  dragging  responsibility,  for  the  rearing  of 
children  to  her  is  not  a  care  but  a  joy.  There 
are  many  groups  of  children  which  have  the 
same  intelligence  applied  to  their  feeding  and 
to  all  the  other  conditions  of  their  lives,  and 
still  they  are  a  source  of  much  care  and 
anxiety.  The  one  simple  thing  that  makes 
this  difference  between  care  and  joy  is  the 
open  air. 

I  do  not  know  that  adults  who  sleep  out  of 
doors,  aside  from  their  freedom  from  colds,  are 
much  different  from  other  adults,  but  children 
are  decidedly  different.  I  once  heard  Judge 
Lindsey  say  that  a  judge  in  a  neighboring  State 
gave  up  treating  with  clement  consideration 
youthful  offenders  against  the  law,  because  he 
had  once  tried  it  and  the  boy  had  run  away. 
This  is  about  the  same  attitude  as  that  pos- 
sessed by  the  man  who  said  that  he  once  tried 
sleeping  with  his  windows  open  and  he  caught  a 
cold  that  lasted  him  all  winter.  Both  of  these 
cases  illustrate  that  a  certain  amount  of  intel- 
ligence must  be  brought  to  bear  even  upon  these 
simple  problems.  When  a  mother  says  that  her 
children,  products  of  the  hothouse,  cannot  sleep 
out  of  doors  because  they  are  not  rugged 
enough,  she  confesses  that  she  has  not  applied 

166 


THE    SOCIOLOGY    OF   HEALTH 

the  stint  of  intelligence  to  the  case  which  its, 
importance  merits. 

For  the  adult,  the  best  of  sleeping  under  the 
open  sky  is  really  not  hygiene.  After  all,  the 
best  thing  is  just  the  joy  of  it.  To  lie  down  to 
sleep  at  night  with  ten  thousand  other  worlds 
in  sight,  all  moving  noiselessly  and  majestically 
upon  their  eternal  errands,  the  greatness  and 
peacefulness  of  it  all  enters  into  one's  own 
spirit  and  shuts  out  the  petty  affairs  of  the 
little  world.  One  feels  that  he  is  clasped  more 
closely  in  the  tender  embrace  of  the  great  uni- 
versal mother  of  all  things.  Sweet  air  bathes 
his  lungs;  the  sounds  of  the  world  grow 
fainter;  and  to  the  music  of  the  stars  he  drops 
into  slumber.  Then  the  sun  god  comes  and 
paints  the  objects  all  about  with  gold;  brown 
chimneys  look  like  minarets  of  the  temple; 
the  fleecy  clouds  quicken  their  flight;  the  birds 
are  on  the  wing;  and  the  day  has  awakened. 
High  in  the  air  the  belly  of  a  gull  shines 
like  a  cuirass  of  silver,  as  it  beats  the  air  with 
glistening  wings  that  seem  to  splash  a  golden 
spray.  The  long,  serpentine  chain  in  the  sky 
swiftly  moving  to  the  north  proclaims  the 
spring  prophecy  of  migrating  ducks.  It  is  a 
great  thing  for  one  to  feel  that  he  is  a  part 

167 


MEDICAL    SOCIOLOGY 

of  nature  as  well  as  of  the  busy  conununity  of 
selfish  men.    It  broadens  him  immeasurably. 

Go  out  into  the  air ;  do  not  despise  it  because 
it  is  cheap  and  plentiful ;  bathe  your  body  in  it ; 
absorb  it  into  your  blood ;  and  it  will  bless  you 
with  the  benediction  of  health. 


CHRISTIAN    SCIENCE 

"There  is  in  our  mind  nothing  that  has  not  been  in  our 
senses." — Moleschott. 

CHRISTIAN  science  is  performing  a  dis- 
tinct function.  It  is  filling  with  op- 
timism the  hearts  of  many  people  who 
have  been  racked  with  imsatisfied  longings,  dis- 
appointments, and  distress.  It  has  bestowed 
"upon  them  a  beneficent  laissez  faire.  Nothing 
matters.  Berkeley  failed  to  secure  a  following 
because  he  attempted  an  appeal  to  the  intellect. 
The  founder  of  Christian  science  succeeded  be- 
cause she  appealed  to  the  superstitions,  and  to 
self-interest. 

This  doctrine  is  not  to  be  feared,  because  the 
cultured  mind  is  not  susceptible  to  its  influ- 
ences. Those  who  adopt  it  are  possessed  al- 
ready of  unnatural  delusions  or  are  deficient 
in  knowledge  of  the  nature  of  things.  Two  con- 
ditions exclude  this  dogma :  good  mental  poise, 
and  familiarity  with  the  natural  sciences. 

169 


MEDICAL    SOCIOLOGY 

The  peculiarity  of  Christian  science  is  that 
it  recognizes  no  evil ;  nothing  ill  can  befall  one ; 
all  is  good  and  to  be  greeted  benignly  and  with 
a  smile  of  approval;  whereas  the  wise  man 
believes  that  life  is  a  mixture  of  good  and  ill. 
While  there  is  much  happiness,  there  is  also 
much  unhappiness.  Those  who  are  helping  hu- 
manity are  striving  to  increase  the  amount  of 
happiness  and  diminish  the  amount  of  unhap- 
piness; and  they  are  succeeding  fairly  well. 
But  it  is  a  slow  and  hard  struggle.  Reducing 
infant  mortality;  diminishing  the  hazard  of 
childbirth;  saving  the  wounded;  making  the 
hazardous  occupations  more  safe;  securing 
more  hygienic  dwellings  for  the  poor ;  lowering 
the  morbidity  from  tuberculosis,  typhoid  fever, 
cholera,  and  plague;  and  minimizing  by  arbi- 
tration the  danger  of  war — these  are  a  few  of 
the  things  which  occupy  humanity.  But  in 
these  efforts  to  make  life  sweeter,  in  the  move- 
ments which  constitute  civilization  itself,  no 
help  can  be  expected  from  the  unnatural  person 
who  denies  that  there  is  any  evil  to  fight.  The 
infant  may  be  fed  infected  food — it  is  not  sick. 
The  woman  in  labor  needs  no  skilled  attention 
— she  will  not  bleed  or  become  infected.  The 
wounded  need  not  have  his  wound  cleansed — 

170 


THE    SOCIOLOGY    OF   HEALTH 

dirt  can  do  him  no  harm.  The  miner  descend- 
ing into  the  earth  need  not  concern  himself  if 
the  rope  is  decayed — if  it  breaks,  the  fall  will 
not  injure  him.  The  poor  may  live  without  sun- 
shine or  fresh  air  in  their  rooms — all  is  good. 
The  tuberculous  may  expectorate  where  his 
sputum  enters  our  food — but  we  shall  not  con- 
tract tuberculosis.  Sewage  may  flow  into  our 
well — but  typhoid  will  pass  us  by.  The  cholera 
and  plague  need  not  be  quarantined  against — 
they  will  not  enter  our  ports.  Men  may  go  to 
war — the  enemy  will  do  them  no  harm.  Thus 
says  Christian  science.  But  history  and  sci- 
ence and  all  our  senses  tell  us  that  by  giving 
heed  to  these  things,  lives  have  been  saved  and 
happiness  added  to  man's  lot. 

Christian  science  recognizes  all  the  good  in 
life,  and  makes  the  most  of  it,  which  is,  indeed, 
most  admirable;  but  I  charge  this  unnatural 
system  with  turning  its  back  upon  the  world's 
cry  of  pain.  The  suffering  and  distressed  we 
have  with  us;  bodies  deformed,  diseased,  and 
racked  with  pain  are  here;  women  are  being 
led  into  lives  of  shame;  tender  children  are 
wasting  in  our  mills;  the  innocent  are  con- 
tracting preventable  diseases;  victims  of  pes- 
tilence, disaster,  shipwreck,  and  earthquake  are 

171 


MEDICAL   SOCIOLOGY 

crying  for  help.  The  agony  of  a  man  with 
nerves  caught  in  a  machine  should  excite  our 
desire  to  extricate  him;  and  the  agony  of  one 
whose  nerve  is  compressed  by  a  minute  infec- 
tion which  can  be  seen  only  by  the  microscope 
should  excite  our  desire  to  give  relief.  But  the 
relief  of  neither  of  these  is  by  sweet  smiles  and 
assurances  that  there  is  no  pain.  We  can  offer 
the  sufferer  something  better. 

I  charge  this  unnatural  system  with  cruelty. 
I  have  seen  the  sufferings  of  the  unfortunate 
dupes  of  this  delusion.  I  have  seen  the  hand 
withheld  that  should  have  plucked  the  burning 
iron  from  the  breast.  I  have  seen  them  racked 
with  pain  till  their  faces  were  distorted,  while 
through  their  tears  they  feebly  murmured, 
"  There  is  no  pain."  I  have  seen  them  sink  into 
unconsciousness  and  die;  and  heard  the  weep- 
ing orphans  told,  "  He  is  not  dead."  It  does  not 
ease  suffering  or  change  conditions  to  stand 
idly  by  and  say  that  the  conditions  do  not  exist. 

Christian  science  is  a  feminine  institution 
and  displays  the  weakest  side  of  woman.  The 
Christian  scientist  recognizes  a  hole  in  the 
ground,  but  not  the  cavity  in  a  tuberculous  lung. 
Tens  of  thousands  of  autopsies  have  shown 
these  cavities,  but  the  Christian  scientist  has 

172 


THE    SOCIOLOGY    OF   HEALTH 

not  seen  them.  If  a  telephone  wire  is  eaten  in 
two  by  rust,  she  will  confess  that  she  ceases  to 
hear  the  voice  at  the  other  end  of  the  wire ;  but 
if  a  diseased  condition  causes  the  decay  and 
breaking  of  the  continuity  of  a  nerve,  she  de- 
nies that  the  muscles  supplied  by  that  nerve  are 
paralyzed.  The  Christian  scientist  has  resur- 
rected the  teaching,  promulgated  nineteen  hun- 
dred years  ago,  to  "  Take  no  thought  of  your 
life,  what  ye  shall  eat  or  what  ye  shall  drink,  nor 
yet  of  your  body."  However,  she  is  fond  of  the 
good  things  of  the  table,  not  oblivious  to  the 
bad,  and  I  should  not  like  to  try  the  experiment 
of  administering  to  her  unbeknown  either  prus- 
siate  of  potash  or  a  culture  of  typhoid  bacilli. 
While  she  insists  that  the  effects  of  such  things 
are  entirely  mental,  one  of  the  most  instructive 
experiments  that  I  have  ever  witnessed  was  to 
see  a  member  of  this  cult  empty  her  stomach  in 
response  to  an  hypodermic  injection  of  one 
tenth  of  a  grain  of  apomorphine.  Not  all  is 
mind ;  there  is  much  matter. 

It  may  be  that  when  the  plague  swept  over 
Europe  in  the  sixteenth  century  the  twenty  mil- 
lion people  who  sickened  and  died  had  an  im- 
aginary disease.  It  may  be  that  the  flames  that 
leaped  up  about  the  victims  of  the  Inquisition 

173 


MEDICAL    SOCIOLOGY 

did  not  burn  them.  It  may  be  that  the  pock- 
marked population  of  England  before  the  days 
of  vaccination  had  had  no  disease.  It  may  be 
that  the  thousands  who  died  with  hospital  gan- 
grene before  the  time  of  antiseptic  surgery 
were  deluded  into  thinking  that  their  wounds 
were  infected.  It  may  be  that  the  200,000 
who  perished  in  the  earthquake  in  Italy  in 
1909  were  deluded  into  thinking  that  there 
was  an  earthquake.  But  the  well-balanced 
and  the  educated  mind  knows  that  these  things 
occurred,  and  that  man  is  an  animal  subject 
to  physical  laws  that  govern  matter.  He  falls 
like  a  stone,  responsive  to  gravity.  His  albu- 
minous structures  undergo  changes  and  decay 
like  those  of  a  rat. 

Physicians  know  that  the  great  majority  of 
diseases  are  self -limiting  and  self -curing.  Natu- 
ral history  teaches  this.  Were  it  not  so,  the  race 
of  man  would  have  become  extinct.  In  not  one 
case  in  ten  does  an  educated  physician  expect 
to  limit  to  any  very  considerable  degree  the 
course  of  a  disease.  But  what  he  is  able  to  do 
is  to  relieve  symptoms,  make  the  sufferer  com- 
fortable, aid  Nature  in  the  direction  that  she  is 
taking  to  cure  the  malady,  thwart  Nature  when 
her  tendency  is  toward  aggravation  of  the  dis- 

174         y 


THE    SOCIOLOGY    OF   HEALTH 

ease,  and  tlieii  in  the  one  case  in  ten  or  twenty 
or  more  he  is  able  by  his  ministrations  to  turn 
the  fatal  tendency  of  a  disease  toward  recovery 
and  save  a  human  life.  But  this  is  not  the  best 
that  the  physician  is  doing.  He  is  studying  the 
nature  and  effects  of  the  organisms  which  find 
entrance  into  our  bodies  and  produce  changes 
there,  just  as  the  arboriculturist  studies  the 
parasites  of  our  fruit  trees,  or  the  geologist 
studies  the  coral  islands.  He  is  finding  means 
of  combating  these  parasites.  He  is  learning 
and  teaching  how  to  recognize  diseases  and  how 
to  prevent  them.  It  is  an  important  thing  for  a 
person  to  know  whether  he  has  a  disease,  and 
what  it  is.  As  a  result  of  medical  knowledge 
and  medical  administration,  fewer  people  are 
dying.  There  are  thousands  of  earnest  men 
the  world  over  giving  their  lives  to  these  ends. 
Might  it  not  be  pertinent  to  inquire  what  is  this 
cult  of  strange  people  called  Christian  scien- 
tists contributing  to  human  knowledge!  Are 
there  any  laboratories  where  they  are  seeking 
to  add  a  fact  to  human  wisdom?  Have  they 
discovered  any  of  the  great  truths  of  nature 
on  account  of  our  ignorance  of  which  we  suffer  ? 
Man  was  once  so  ignorant  of  natural  science 
that  he  was  persecuted  by  superstitions  day  and 
13  175 


MEDICAL    SOCIOLOGY 

mght.  There  is  much  still  to  be  learned.  Are 
these  people  helping  to  gain  knowledge  of  the 
things  that  differentiate  us  from  the  beasts'? 
The  answer  which  they  give  to  these  questions 
is  that,  all  is  good ;  we  need  not  learn  anything 
of  the  things  that  harm  us,  no  harm  can  come 
if  the  mind  wills  it  not  to  come ;  there  is  no  sick- 
ness, pain,  or  death.  They  philosophize  with 
wishes  instead  of  with  facts.  They  rise  above 
knowledge,  and  their  attitude  toward  science  is 
one  of  supercilious  contempt.  They  say,  "  A 
drug  cannot  of  itself  go  to  the  brain  or  affect 
cerebral  conditions  in  any  manner  whatever." 
But  what  do  they  know  about  it?  Have  they 
tried  the  experiment  upon  men  or  upon  ani- 
mals? Have  they  studied  experimentally  the 
effects  of  morphine?  With  the  Christian  sci- 
entists thought  is  the  thing.  But  they  fail  to 
realize  that  the  thoughts  which  have  helped 
mind  to  conquer  matter  have  been  the  thoughts 
of  such  men  as  have  produced  the  steam  engine, 
and  harness  electricity  for  our  uses,  and  not  the 
thoughts  that  emanate  from  the  ignorant  or 
from  the  easy-chair,  and  which  are  concerning 
the  mind  and  come  back  to  the  mind  again. 
The  history  of  the  Middle  Ages  has  taught  us 
that  the  tendency  to  exalt  the  soul  to  the  neg- 

176 


THE    SOCIOLOGY    OF    HEALTH 

lect  of  the  body  is  ever  fraught  with  danger. 
The  mental  healers'  use  of  the  word  "  thought  " 
is  with  little  idea  of  its  real  meaning.  Her 
mind  may  be  stored  with  vagaries,  which  she 
recalls  and  repeats,  but  she  is  not  prone  to  orig- 
inate a  thought.  Such  mental  processes  are 
in  nowise  comparable  to  the  thoughts  of  Dar- 
win, Tyndall,  or  Edison,  who  think  of  facts  and 
things  because  they  have  seen  them,  not  simply 
of  mind. 

Persons  whose  minds  are  susceptible  to  these 
vagaries  are  still  in  the  childhood  stage  of  men- 
tal development.  They  love  to  talk  of  the  great 
when  they  have  not  yet  learned  of  the  small. 
They  like  big  talk.  They  discuss  God  and  the 
infinite  when  they  do  not  know  nature  and  the 
finite.  They  are  like  the  small  boy  who  is  Cap- 
tain Kidd,  in  command  of  a  great  ship,  when 
he  should  mind  his  mother  and  run  along  and 
hoe  the  potatoes.  There  is  too  much  grop- 
ing after  the  great  and  remote  things  by  minds 
that  have  not  grasped  the  simple  nearby  things. 
The  more  ignorant  of  facts  a  person  is  the  more 
prone  is  he  to  turn  his  mind  to  the  infinite  and 
the  supernatural;  the  more  deeply  one  is 
learned  in  the  natural  sciences,  the  facts  of  the 
tangible  things,  the  less  time  does  he  spend 

177 


MEDICAL    SOCIOLOGY 

in  consideration  of  tlie  infinite  and  unnatural. 
The  scientific  man  is  not  in  danger  of  taking 
up  with  these  strange  cults. 

The  ultimate  appeal  of  the  Christian  scien- 
tist, like  the  patent-medicine  man,  is  to  results. 
We  cure,  they  say.  The  wise  man  says,  nature 
cures  for  you,  and  you  take  the  money.  They 
point  to  the  good  people  who  have  embraced  the 
faith.  But  it  is  well  known  that  credulity  is 
often  associated  with  intellect.  Persons  of  in- 
tellect are  not  altogether  free  from  the  danger 
of  falling  into  the  hands  of  the  charlatan  or 
taking  up  with  strange  cults.  There  are  many 
good  and  intelligent  people  who  believe  that 
their  future  happiness  depends  upon  their 
thinking  that  woman  was  made  from  the  rib 
of  a  man,  that  a  child  was  bom  of  a  \drgin, 
that  the  sun  once  stood  still  in  the  heavens  at 
the  command  of  a  man  who  desired  to  make 
the  day  longer  in  order  to  give  him  more  time 
to  kill  his  enemies,  that  five  thousand  hungry 
people  were  once  fed  to  satiety  on  five  loaves 
and  two  small  fishes.  These  are  not  more 
strange  or  less  unnatural  than  the  beliefs  of 
Christian  science.  There  are  spiritualists  who 
are  hard-headed  business  men.  Let  us  not  be 
asked  to  judge  of  things  by  the  good  people 

178 


THE    SOCIOLOGY    OF   HEALTH 

who  believe  them.  Let  us  go  to  nature  and 
learn  the  truth  at  first  hand. 

We  are  interested  in  the  Christian-science 
cult  because  it  is  new,  not  because  it  is  unusual ; 
because  of  its  importance  to  those  who  are  sick 
with  fatal  but  curable  maladies ;  and  because  of 
the  light  it  throws  upon  the  imperfections  of 
the  miad  as  a  reasoning  mechanism.  There 
are  few  more  interesting  exhibits  of  the  power 
of  the  human  mind  to  becloud  a  subject  with  a 
jumble  of  unintelligible  jargon  than  can  be  wit- 
nessed when  one  of  these  people  is  asked,  How 
is  the  insane  man,  whose  mind  is  defectively 
operative  because  of  a  tumor  of  the  brain,  to 
free  himself  from  sickness,  pain,  and  death? 
How  is  the  new-bom  babe,  which  has  neither 
thought  nor  language,  to  free  itself  from  the 
effects  of  dirty  milk  ?  How  are  the  lower  animals 
to  know  that  sickness,  pain,  and  death  do  not 
exist?  How  is  the  poor  benighted  savage  to 
know  that  he  is  not  sick  and  dying  when  his 
heart  is  growing  weaker  and  his  eyes  more  dim, 
and  the  vital  functions  slowly  ceasing?  Is  the 
absence  of  sickness,  pain,  and  death  a  special 
benison  for  those  who  purchase  the  text-book 
of  Christian  science? 

Christian  science  is  one  of  those  interesting 
179 


MEDICAL    SOCIOLOGY 

vagaries  that  liave  from  time  immemorial  be- 
come fastened  upon  certain  susceptible  minds. 
They  come  and  go.  Its  chief  harm  is  that  it 
discourages  the  appreciation  of  the  value  of 
knowledge,  and  denies  the  observations  of  the 
senses. 

We  are  human  creatures,  not  gods.  Our 
senses  are  our  best  guides.  It  is  through  them 
that  we  know  the  outside  world.  If  we  deny 
them,  we  close  out  the  light  of  day.  And  in 
our  darkness  it  matters  not  whether  we  imag- 
ine the  chambers  of  our  abode  filled  with  beauty 
and  with  light,  it  is  still  dark.  The  blind  do 
not  see.  It  is  impossible  for  light  to  pass 
through  an  opaque  lens. 

Let  us  have  charity  and  kindness  for  these 
people,  and  remember  that  most  of  mankind 
cherish  delusions  which  are  contrary  to  the  ex- 
periences of  the  senses  and  to  the  understand- 
ing of  the  intellect.  "We  have  not  yet  reached 
that  state  of  mental  development  when  the  un- 
natural can  be  cast  out. 


XXI 

THE   EMMAITUEL    MOVEMENT    AND    KINDEED 
PHENOMENA 

THE  fact  that  Christian  science  is  reach- 
ing a  large  number  of  people  with  psy- 
chic ailments  warrants  the  belief  that 
there  is  a  middle  ground  between  the  people 
who  deny  the  materiality  of  things  and  those 
who  believe  only  in  material  things  and  the 
natural  forces  which  connect  them.  There  are 
comparatively  few  people  who  have  purged 
their  minds  of  superstition,  so  that  these  move- 
ments have  a  wide  application.  Aside  from 
their  appeal  to  unnatural  agencies,  they  have 
entered  a  field  which  is  properly  medical,  but 
which  medicine,  busy  with  its  old-fashioned 
therapy,  has  failed  to  develop;  that  is  repre- 
sented in  psychology,  the  inculcation  of  hope- 
fulness, the  distracting  of  the  mind  from  im- 
aginary ills,  and  the  great  power  of  suggestion. 
But  this  is  a  medical  province,  and  medicine  is 
more  capable  of  developing  it  than  the  clergy. 

181 


MEDICAL    SOCIOLOGY 

The  clergymen  who  originated  the  Emman- 
uel movement  went  about  it  in  a  manner  which 
has  not  invited  criticism,  and  have  striven  to 
antagonize  scientific  medicine  in  no  way.  It  is 
an  evidence  of  how  the  modem  dominant  su- 
perstitions can  be  put  in  harness  with  a  great 
psychic  principle  and  made  to  do  service  for 
the  mentally  deranged. 

This  movement  now  has  gotten  entirely  away 
from  its  originators  and  is  fast  becoming  wide- 
spread. Its  destiny  is  to  add  testimony  to  the 
value  of  psychic  influence  in  the  treatment  of 
diseases.  It  does  some  good  and  much  harm. 
People  who  have  ills  are  prompted  to  appeal 
to  agencies  outside  of  nature,  and  they  recover 
from  their  ills.  Most  would  have  recovered  had 
they  appealed  to  natural  agencies,  because  most 
illnesses  tend  to  recovery  no  matter  what  is 
done.  But  these  people  already  provided  with 
superstition,  when  they  find  that  they  have  re- 
covered, attribute  the  change  to  an  extranatu- 
ral  power  influencing  natural  phenomena;  and 
the  result  is  that  they  become  more  deeply 
steeped  in  superstition  than  before.  They  con- 
fuse post  hoc  with  propter  hoc.  If  there  is  any 
one  thing  that  has  kept  humanity  in  ignorance 
and  degradation  it  has  been  the  superstitions, 

182 


THE    SOCIOLOGY    OF    HEALTH 

not  the  least  of  which  is  that  which  conditions 
the  existence  of  a  great  extranatural  power 
which  can  be  induced  by  certain  means  of  solici- 
tation and  entreaty  to  change  the  natural 
course  of  events  which,  without  such  solicita- 
tion and  entreaty,  would  not  be  changed.  This 
is  one  of  the  most  degrading  of  the  supersti- 
tions fostered  by  some  of  the  systems  of  re- 
ligion. Science  is  making  a  successful  contest 
against  it,  and  the  minds  of  the  people  are  rid- 
ding themselves  of  this  incubus  and  obstacle  to 
moral  and  intellectual  progress.  These  healing 
movements  of  a  religious  character  cannot 
much  interfere  with  the  march  of  science;  but 
they  can  strengthen  the  hold  of  superstition 
upon  minds  which  might  otherwise  have  shaken 
it  off  and  become  free  to  receive  enlightening, 
natural  truths.  We  should  have  little  sympathy 
with  doctrines  that  are  recommended  because 
they  have  the  power  to  relieve  an  individual  of 
certain  ills,  when  in  so  doing  they  implant  a 
falsehood  in  his  mind,  which  sooner  or  later  will 
cause  him  harm,  and  also  make  him  the  center 
from  which  radiates  to  others  the  pernicious  in- 
fluences of  false  testimony. 

So  far  as  the  Emmanuel  movement  goes,  it 
has  spread  widely  over  the  country,  but  even 

183 


MEDICAL    SOCIOLOGY 

now  it  makes  no  pretense  to  keep  within  tlie 
bounds  of  discretion  stipulated  by  the  Emman- 
uel Church.  It  is  doubtful  if  there  is  another 
church  in  America  where  it  is  confined  within 
reasonable  limits.  An  enormous  brood  of  heal- 
ing systems  have  been  hatched  out  of  it.  The 
text  now  is,  "  Christ  healed  the  sick,  let  us  do 
the  same." 

These  movements  are  being  seized  upon  by 
the  Church,  in  the  superstitions  of  which  the 
people  in  their  enlightened  progress  are  fast 
losing  interest;  and,  as  a  practical  and  tangible 
means  of  attracting  attention  and  rendering 
apparent  help  to  the  afflicted,  they  are  destined 
to  be  widely  exploited.  That  means  the  break- 
ing loose  from  the  plans  laid  down  by  the 
original  church  in  Boston,  and  the  ultimate 
"healing  of  the  sick"  as  a  priestly  function 
without  medical  intervention.  And  it  will  suc- 
ceed for  the  same  reason  that  charlatanism,  the 
patent-medicine  business,  and  Christian  science 
succeed.  That  reason  is,  because  where  ten 
people  are  sick  nine  will  recover,  irrespective  of 
whether  they  are  treated  by  the  laying  on  of 
hands,  by  the  taking  of  a  bottle  of  colored  water, 
or  by  appeals  for  intervention  addressed  to  an 
extranatural  power,  or  to  a  graven  image.    It 

184 


THE    SOCIOLOGY    OF    HEALTH 

is  a  winning  game.  So  long  as  more  than  fifty 
per  cent  recover  it  will  succeed.  If  forty-nirie 
say,  it  did  me  no  good,  and  fifty-one  say,  it 
helped  me,  it  gains  two  recruits ;  but  when  the 
figures  become  as  ten  to  ninety  simply  by  virtue 
of  the  tendencies  of  nature,  we  see  the  enormous 
advantage  nature  gives  to  any  system  of  heal- 
ing exploiting  itself  for  public  support.  Eegu- 
lar  medicine,  happily,  enjoys  the  same  ad- 
vantage. 

The  influence  of  the  mind  over  the  healthy 
body  is  very  great,  but  the  influence  of  the  mind 
over  diseases  of  the  body  is  very  slight.  Morbid 
processes  in  the  tissues  of  the  body,  commonly 
called  diseases,  are  so  distinctly  the  product  of 
physical  causes  that  takiQg  thought  of  them  has 
little  effect  one  way  or  the  other.  This  has  been 
pretty  thoroughly  tried.  The  Indian  medicine 
man,  the  voodoo  doctor,  Lourdes  and  the  saints, 
have  all  testified  that  actual  diseases  are  not 
much  influenced  by  the  mind.  History  shows 
that  these  methods  have  done  more  harm  than 
good.  A  person  with  a  tuberculous  joint,  who 
throws  away  his  splint  and  declares  that  he  is 
well,  eventually  pays  dearly  for  his  faith;  but 
that  is  not  all:  what  is  still  worse  he  prompts 
others  to  do  the  same.    And  since  these  places 

185 


MEDICAL    SOCIOLOGY 

do  not  keep  statistics  and  follow  up  their  work 
after  the  ordinary  scientific  methods,  the  de- 
luded followers  witness  only  the  beginnings  of 
the  treatment  but  not  the  end.  When  the  tuber- 
culosis patient  has  worn  his  splint  until  the  in- 
flammation has  subsided  (and  surgical  advice 
is  jDrone  to  be  on  the  safe  side  and  urge  its  use 
until  after  all  possibility  of  disease  has  passed) 
and  then  visits  a  shrine  of  the  saints,  casts 
aside  the  splint,  and  proclaims  that  he  is  cured, 
he  will  find  to  his  joy  that  he  is  cured.  Such 
an  one  is  doubly  dangerous,  because  of  the 
harm  of  his  influence  ujDon  others. 

On  the  other  hand,  the  influence  of  the  body 
upon  the  mind  is  very  great;  and  the  more 
medicine  is  learning  of  it  the  more  its  impor- 
tance is  being  realized.  Nervous  diseases  are 
now  most  successfully  treated  by  the  scientific 
method  which  seeks  for  the  physical  basis  of 
the  disease.  The  first  requisite  in  the  treat- 
ment of  mental  derangements  is  the  hygiene  of 
the  body.  The  insane  did  poorly  in  former 
days  when  it  was  supposed  that  they  were  pos- 
sessed of  evil  spirits  and  devils,  and  were  con- 
fined in  unwholesome  cells.  They  are  now  re- 
covering in  our  modern  scientific  institutions, 
where  they  are  put  at  useful  work  in  the  open 

186 


THE    SOCIOLOGY    OP   HEALTH 

air  on  the  farms,  given  wholesome  food,  and 
made  to  keep  their  bodies  clean  and  their  hands 
occupied.  The  novelists  and  story  writers  pass 
along  the  traditions  of  the  heart  stopping,  the 
hair  suddenly  turning  gray,  and  birthmarks 
being  produced  by  thought ;  but  the  authentica- 
tion of  these  things  is  not  to  be  had.  Persons 
with  the  so-called  imaginary  diseases,  for  which 
no  physical  basis  can  be  found,  it  is  safe  to  as- 
sume have  some  slight  physical  derangement. 
Time,  the  great  healer,  may  cure  them;  medi- 
cine, to  numb  the  feeling  of  discomfort  while 
recovery  is  taking  place,  will  often  be  given  the 
credit;  infusing  the  mind  with  the  opium  of 
oiDtimism  and  hope  may  be  assumed  to  have  the 
curative  power;  but  in  ninety -nine  per  cent  of 
cases  life  in  the  fresh  air,  occupation,  clean- 
liness, simple  nourishing  food,  and  hygienic 
regulation  of  the  bodily  functions  will  give 
quicker  cures  than  medicines,  hypnotism,  or 
prayer. 

The  Emmanuel  movement  will  give  better  re- 
sults in  the  long  run  if  it  is  turned  into  a  fresh- 
air  movement. 

To  sit  down  with  an  unhappy  victim  of  per- 
verted  notions,  or  one  whose  mind  has  been  con- 
fused by  theories  and  introspection,  or  one  who 

187 


MEDICAL    SOCIOLOGY 

lias  not  a  sufficient  grasp  of  real  facts,  and  talk 
common  sense  to  him,  is  an  admirable  service. 
This  is  the  duty  of  everyone,  be  he  physician, 
clergyman,  or  neighbor.  But  let  it  not  be  sup- 
posed that  this  is  what  these  "  psychic  move- 
ments "  do.  They  have  broken  away  from 
plain  common  sense  and  gone  up  into  the  air; 
and  the  few  men  who  have  tried  to  treat  the 
matter  in  a  scientific  manner  have  been  left 
forsaken  and  branded  as  unspiritual. 

That  these  movements  will  foster  a  system 
of  quackery  there  can  be  little  doubt.  A  man 
who  in  the  name  of  morality  and  religion  can 
stand  before  people  and  declare  for  such  things 
as  in  his  heart  he  does  not  believe,  and  which 
in  private  conversation  he  will  deny,  I  think 
would  trade  in  the  credulity  of  the  supersti- 
tious ;  and  after  the  laying  on  of  hands  or  some 
other  formality,  if  the  patient  recovered,  as 
most  likely  would  be  the  case,  he  would  en- 
courage the  patient  in  the  belief  that  through 
his  agency  an  extranatural  voluntary  power 
had  been  induced  to  interfere  with  the  disease 
and  the  patient  had  been  made  well.  This  move- 
ment cannot  be  kept  in  the  hands  of  the  discreet 
and  honorable  men  with  whom  it  originated; 
it  is  particularly  adapted  to   the  ecclesiastic 

188 


THE    SOCIOLOGY    OF    HEALTH 

charlatan,  and  in  his  hands  it  is  destined  to  be- 
come a  refined  system  of  quackery. 

The  people  best  qualified  for  the  treatment  of 
disease  are  those  who  are  familiar  with  the 
anatomy,  physiology,  and  pathology  of  the  hu- 
man organism.  Let  the  cobbler  stick  to  his  last. 
"When  the  clergyman,  following  the  lead  of  the 
people,  ceases  from  superstitions,  before  taking 
up  the  practice  of  medicine  let  him  turn  to  the 
teaching  of  morality  and  ethics  and  lend  a  hand 
in  the  improvement  of  social  conditions.  These 
are  the  fields  into  which  he  is  destined  by  evo- 
lution to  be  directed,  and  in  which  he  can  be  of 
great  service  to  humanity. 


o 


XXII 

OSTEOPATHY 

STEOPATHY  is  defined  by  the  osteo- 
healing  which  treats  diseases  of  the 
paths  as  "  that  science  or  system  of 
human  body  by  manual  therapeutics  for  the 
stimulation  of  the  remedial  forces  within  the 
body  itself,  for  the  correction  of  misplaced  tis- 
sue, and  the  removal  of  obstructions  or  interfer- 
ences with  the  fluids  of  the  body,  all  without  the 
internal  administration  of  drugs  or  medicines." 
This  would  be  all  right  were  it  not  for  the  fact 
that  the  osteopath  treats  all  internal  diseases 
and  regards  them  all  as  being  due  to  these  pe- 
culiar causes  which  he  enumerates.  Here  is 
the  danger  of  a  general  system  of  treatment 
which  fails  to  take  cognizance  of  the  anatomy 
of  disease. 

It  should  be  well  known  that  the  administra- 
tion of  medicines  is  but  a  minor  part  of  the 
science  of  medicine.  Medicine  is  occupied  with 
discovering  the  causes  and  the  means  of  preven- 

190 


THE    SOCIOLOGY    OF   HEALTH 

tion  of  diseases.  Hygiene,  sanitation,  legal 
medicine,  and  public  health  are  subjects  of  its 
study.  It  is  the  science  which  connects  biology 
with  the  practical  saving  of  life  and  the  relief 
of  physical  suffering.  It  has  made  smallpox 
a  rare  disease ;  it  has  deprived  diphtheria  of  its 
power  to  destroy;  it  has  stopped  the  spread  of 
contagions;  it  has  reduced  the  mortality  in 
more  than  half  of  the  diseases  of  the  human 
family ;  and  it  now  points  out  to  the  state  how 
typhoid  fever  may  be  eliminated.  Legislation, 
admitting  into  the  practice  of  medicine  persons 
who  lack  medical  training,  lowers  the  standard 
of  medical  practice  and  recognizes  and  licenses 
to  practice  medicine  persons  who  are  not  edu- 
cated or  professionally  interested  in  these  most 
important  departments  of  medicine.  Such  leg- 
islation allows  the  so-called  osteopath  to  diag- 
nose, treat,  and  have  under  his  consideration 
cases  of  contagious  disease,  when  his  art  is, 
at  the  best,  a  system  of  massage.  It  allows  him 
to  diagnose,  treat,  and  sign  the  death  certificate 
in  criminal  cases  of  poisoning  when  he  dis- 
claims an  interest  in  the  physiology  of  drugs 
and  other  poisons. 

The  practices  of  value  in  "  osteopathy  "  have 
long  been  known  to  medicine.    It  is  one  of  many 
14  191 


MEDICAL    SOCIOLOGY 

measures  used  in  the  branch  of  medicine  called 
therapeutics.  Therapeutics  includes  massage, 
electricity,  passive  motions,  dietetics,  medica- 
tion, hydrotherapy,  rest,  exercise,  heat,  cold, 
poultices,  counter  irritation,  etc.  These  so- 
called  "  displacements  of  tissues  "  with  which 
the  osteopath  concerns  himself  have  little  or 
no  basis  in  the  pathology  of  disease.  Diseased 
tissues  have  been  studied  earnestly  for  many 
hundreds  of  years,  but  the  peculiar  conditions 
which  the  osteopath  can  feel  through  the  skin 
have  not  been  revealed  by  knife  or  microscope. 
There  are  certain  slight  dislocations  of  verte- 
brae which  have  their  own  peculiar  symptoms. 
A  knowledge  of  anatomy  and  physiology  eas- 
ily explains  these  symptoms.  But  the  osteo- 
path, without  understanding  bacteriology  or 
the  nature  of  infections,  attributes  infectious 
diseases  to  these  displacements. 

Osteopathy  was  "  discovered  "  by  a  Dr.  A.  T. 
Still,  a  physician  in  Missouri,  who,  in  his  biog- 
raphy, reveals  its  origin.    He  says: 

Who  discovered  osteopathy?  Twenty-four  years  ago,  the  22d 
day  of  next  June,  at  ten  o'clock,  I  saw  a  small  light  on  the  hori- 
zon of  truth.  It  was  put  in  my  hand,  as  I  understood  it,  by  the 
God  of  nature.  That  light  bore  on  its  face  the  inscription:  This 
is  my  medical  library,  surgery  and  obstetrics.  This  is  my  book 
with  all  directions,  instructions,  doses,  sizes,  and  quantities  to 

192 


THE    SOCIOLOGY    OF   HEALTH 

be  used  in  all  cases  of  sickness  and  birth,  the  beginning  of  man: 
in  childhood,  youth  and  declining  days.  I  am  something  of 
what  people  call  "inspired." 

This  piece  of  rhetoric  lies  at  the  foundation 
of  osteopathy;  and  we  have  seen  certain  of  our 
legislatures,  delegated  to  safeguard  our  in- 
terests, our  educational  standards,  and  our 
health,  declare  for  it  and  place  it  upon  the  cata- 
logue of  educational  requirements. 

Such  systems  as  this  come  and  go.  History 
is  full  of  them.  And  among  their  followers 
have  always  been  those  whose  very  standing 
have  helped  to  give  them  impetus.  This  thing 
will  shortly  pass  into  history  with  the  rest  and 
be  forgotten. 

That  many  chronic  cases  of  inflammations, 
pains,  and  neurasthenic  illnesses  have  been  re- 
lieved by  massage  is  as  true  as  that  many  seri- 
ous and  acute  conditions  have  been  aggravated 
by  it.  Any  "  system  "  will  prosper  if  it  does 
not  do  too  much  harm,  for  the  natural  tendency 
of  diseases  is  to  recover.  Therapeutics  is  but 
one  of  the  departments  of  medicine,  and  to  ex- 
alt one  of  the  many  therapeutic  measures  to 
the  position  of  the  whole  science  and  art  of 
medicine  can  be  designated  only  as  unwise. 


XXIII 

FACTS   AND    THEOKIES 

BEWAEE  of  theories.  My  professor  of 
chemistry  and  physics  had  a  theory  that 
the  cost  of  producing  illumination  by 
electricity  would  make  it  utterly  impracticable 
for  general  use ;  and,  moreover,  no  electric  light 
would  be  big  enough  to  read  by,  anyway.  He 
used  to  show  an  electric  light  to  the  class  to 
prove  it.  If  his  experience  with  electricity  had 
been  well  founded,  it  would  have  prompted  him 
to  say,  even  before  the  electric  light  was  spoken 
of :  "  Some  day  this  force  can  be  used  for  pur- 
poses of  illumination  remote  from  the  seat  of 
power."  I  trust  that  this  excellent  man  may 
read  these  lines  by  the  electric  light  in  his  libra- 
ry; and  I  hope  also  that  he  may  recall  with 
happiness  the  theories  which  he  has  fostered 
and  which  have  survived  the  wearing  tests  of 
time  and  experience. 

Beware  of  theories.    When  the  steam  engine 
was  invented,  an  Englishman  wrote  a  book  in 

194 


THE    SOCIOLOGY   OF   HEALTH 

which  he  set  forth  his  theory  that  it  would  be 
impossible  to  propel  a  vessel  across  the  ocean 
by  steam  power.  The  writing  was  lucid,  the 
reasoning  was  correct,  but  the  premises  were 
wrong;  and  the  first  volume  of  this  excellent 
work  that  came  to  America  was  brought  over 
in  a  steamboat,  thereby  demonstrating  that  one 
fact  may  carry  away  a  volume  of  theories. 

"  Experience  teaches,"  it  is  said ;  but  it 
teaches  two  things:  it  teaches  that  which  is 
right  and  it  teaches  that  which  is  wrong.  If 
the  experience  is  based  upon  correct  principles, 
it  will  elevate  and  help;  but  if  it  is  based  on 
error,  and  erroneously  interpreted,  it  only 
serves  to  drag  down.  Suppose  that  a  man 
practices  upon  a  theory  to  which  he  is  commit- 
ted dogmatically — he  has  made  up  his  mind  that 
it  is  right — if  his  assumption  is  an  error,  his 
experience  may  do  him  more  harm  than  good, 
for  he  twists  phenomena  to  fit  his  preconceived 
ideas. 

The  man  who  learns,  who  is  capable  of  learn- 
ing, holds  his  theory-engendering  and  theory- 
harboring  faculty  always  in  abeyance :  he  keeps 
it  in  a  state  of  relaxation  and  openness.  He 
permits  the  ever-flowing  stream  of  facts  to  per- 
colate through  it  and  wash  out  any  theory  that 

195 


MEDICAL   SOCIOLOGY 

cannot  withstand  the  current.  Upon  the  ability 
to  do  this  hangs  the  proposition  that  experience 
teaches  and  helps.  Pity  the  man  who  does  not 
allow  experience  to  change  his  mind. 

Happy  is  he  whose  theories  are  well  foimded 
on  demonstrated  facts  and  so  well  tried  that 
he  is  inspired  by  the  truth  of  his  convictions. 
The  hopeful  persistence  of  Harvey  and  Sem- 
melweis  in  establishing  truths  in  the  face  of 
obstacles  is  an  inspiration  to  every  man  who 
believes  that  he  possesses  the  right  idea. 

"  The  earth  shall  yet  surrender  to  him  and 
the  fates  shall  do  his  will,  who  marches  on, 
though  the  promised  land  prove  to  be  but  a 
mirage,  and  the  day  of  deliverance  be  canceled. 
The  gods  shall  yet  anoint  him  and  the  morning 
stars  shall  sing." 


XXIV 

THE    FAMILY   HAZAED 

GIVEN  a  good  doctor  and  a  sick  man — 
,  just  those  two  alone — and  the  latter  is 
to  be  felicitated  upon  the  situation. 
When  there  is  introduced  the  complication  of 
the  anxious  wife,  the  solicitous  family,  and  the 
critical  neighbor,  Heaven  help  both  doctor  and 
patient,  and  all  of  us !  Many  an  important  life 
has  been  sacrificed  upon  the  altar  of  extramedi- 
cal  solicitude,  when  with  the  same  disease  a 
poor  devil  without  friends  would  recover.  To 
harrow  up  the  doctor's  soul  with  the  anxieties 
over  his  responsibility  warps  judgment,  saps 
vitality,  and  introduces  an  extraneous  element 
with  which  the  doctor  has  no  business  to  deal. 
His  duty  to  every  patient  is  the  same;  it  is 
to  give  his  best  talent  and  skill.  When  the 
life  of  the  Empress  was  in  danger,  Napoleon 
saw  that  the  physician  was  embarrassed  by  his 
great  responsibility.  With  his  extraordinary 
knowledge  of  men  and  his  faith  in  the  conscien- 

19Z 


MEDICAL    SOCIOLOGY 

tious  skill  of  his  physician,  he  said :  "  She  is  but 
a  woman;  forget  that  she  is  the  Empress,  and 
treat  her  as  you  would  the  wife  of  a  citizen  of 
the  Kue  St.  Denis."  The  physician  simply  did 
as  he  thought  was  best  for  his  patient  in  peace 
of  mind  and  confidence,  and  the  Empress  re- 
covered. 

The  best  results  to  both  doctor  and  patient 
accrue  if  the  former  can  concentrate  his  atten- 
tion upon  one  thing — the  proper  treatment  of 
the  case  before  him.  "When  he  has  to  practice 
feints,  and  exercise  his  ingenuity  to  make  his 
conduct  and  practice  conform  to  the  whims  of 
bystanders ;  when  the  demand  for  concealments 
from  some  and  collusions  with  others  are  thrust 
upon  him;  and  when  his  nervous  system  is  as- 
saulted by  alarms  and  solicitations,  the  in- 
terests of  his  patient  are  jeopardized  and  his 
own  days  shortened. 

The  wise  physician  does  the  best  he  can  for 
all.  The  wise  friends  of  patients  spare  him  as 
much  annoyance  as  possible,  and  aim  to  help 
rather  than  to  hinder  him  in  the  work  of  his 
lofty  calling  and  in  the  exercise  of  his  best  skill 
and  judgment. 


XXV 


EATING   AND    TALKING 


WE  are  becoming  convinced  that  thor- 
ough mastication  is  highly  desir- 
able. Confirmed  dyspeptics  are 
curing  themselves  of  their  ailments  by  giving 
more  attention  to  the  chewing  of  their  food. 
In  fact,  of  late,  this  particular  physiological 
function  has  received  much  serious  attention, 
to  the  great  advantage  of  all — to  say  nothing 
of  the  dentists.  But  as  we  contemplate  this  new 
masticatory  era,  we  hark  back  and  encounter 
the  long-accepted  and  time-honored  dictum, 
which  has  never  been  disputed,  that  good  com- 
pany and  conversation  aid  digestion.  It  seems 
that  this  ancient  decision,  born  of  the  round 
table,  the  alehouse,  and  the  "  merrie  companie," 
must  be  reversed  in  the  court  of  the  new  gas- 
tronomy. When  one  is  engaged  with  a  mouthful 
of  food,  he  should  be  unmolested  until  it  is  re- 
solved into  solution. 

Mastication,  as  a  physiological  function,  has 
199 


MEDICAL    SOCIOLOGY 

been  too  much  disturbed  by  the  ancient  dictum 
above  referred  to.  Here  is  the  eater  conveying 
a  loaded  fork  of  nourishment  to  his  mouth;  at 
the  same  moment  his  table  companion  pro- 
pounds a  question  or  utters  a  statement  which 
demands  a  response.  Witness  the  gulping 
down  and  the  responsive  sputterings.  This  is 
no  unusual  scene.  Of  course  there  is  no  ob- 
jection to  talking  in  the  intervals  of  mastica- 
tion, but  this  is  practically  impossible  in  the 
atmosphere  of  so-called  table  good-fellowship. 
It  is  hardly  to  be  expected  that  your  company 
shall  time  the  working  of  his  mind  and  conver- 
sation to  the  working,  so  to  speak,  of  your  jaw. 
That  is  an  Utopian  dream.  It  would  be  strain- 
ing antiphonal  possibilities.  The  invitation, 
"  Let's  go  to  the  Waldorf  and  hear  the  newly 
rich  eat ! "  bears  witness  to  these  contentions. 
Talking  and  eating  mean  often  munching  and 
gulping,  but  not  mastication. 

The  company  of  those  who  understand  us, 
the  company  of  healthy  children,  and  the  com- 
pany of  those  who  do  not  demand  entertain- 
ment from  us,  are  surely  not  undesirable  at 
mealtime;  but  society  which  is  pestiferous  and 
which  demands  talk  is  subversive  to  the  best 
interests    of   the    table.     The   old   dining-hall 

200 


THE    SOCIOLOGY    OF    HEALTH 

legend,  that  conversation  aids  digestion,  is  pre- 
sumably false.  The  notion  that  a  lull  at  the 
table  means  that  the  dinner  is  not  a  success  at 
that  moment,  will  not  bear  the  scrutiny  of  mod- 
ern physiology  any  more  than  it  will  when  two 
or  more,  gathered  together,  are  engaged  in  any 
other  physiological  function.  The  most  impor- 
tant thing  should  have  precedence.  An  ideal 
conversation  at  the  table  would  be  simple  volun- 
tary contributions  of  pleasant  thought  which 
excite  no  immediate  reply  from  anyone  en- 
gaged in  eating.  To  ask  a  chewing  guest  a 
question  is  as  rude  as  to  jostle  his  elbow,  x^ 
appropriate  and  modern  dining-room  motto 
would  be,  "  Let  the  full  mouth  be  undisturbed." 
"  It  is  not  well  for  man  to  eat  alone  "  is  true 
only  provided  his  society  is  agreeable,  intelli- 
gent, and  familiar  with  the  physiological  pro- 
prieties. Otherwise  he  will  do  better  to  conduct 
himself  like  the  lion,  and,  while  he  gnaws  his 
bone,  devote  himself  to  that  function  exclu- 
sively. "When  we  eat,  let  us  eat  as  simple  men 
that  are  nourished  by  their  food. 


PART   II 

MEDICAL    SCIENCE    AND 
MEDICAL    ART 


THE   EVOLUTION   OF   SCIENTIFIC   KNOWLEDGE 

SOME  years  ago,  at  the  Marine  Biological 
Laboratory  at  Woods  Hole,  a  certain 
biologist  was  laughed  at  by  the  undis- 
cerning  because  he  spent  the  summer  at  the 
apparently  unpractical  work  of  studying  the 
biology  of  the  parasites  of  fishes'  fins.  This 
scientific  man  devoted  himself  to  the  proposi- 
tion that  all  information  is  practical;  and  to 
this  thesis  I  dedicate  these  observations  upon 
the  evolution  of  scientific  knowledge. 

The  true  scientist  is  searching  for  knowledge. 
Whatever  it  is  or  wherever  it  is,  he  knows  that 
it  is  one  of  the  links  in  the  chain  of  the  great 
universal  truth ;  and  eventually,  sooner  or  later, 
it  will  be  of  practical  service  to  mankind. 

There  are  two  classes  of  investigators :  those 
who  are  studying  for  ends  of  immediate  utility 
and  practical  application,  and  those  who  are 
at  work  in  the  neglected  and  apparently  un- 
practical fields  of  research.    The  first  have  re- 

205 


MEDICAL   SOCIOLOGY 

ward  and  the  eclat  of  applause  for  tlieir  re- 
sults; the  second  hand  down  to  posterity  some 
new  facts  which  in  their  day  have  found  no 
great  utility,  while  they  have  enjoyed  the  ap- 
proval and  appreciation  only  of  the  select  few 
who  have  known  of  their  work.  All  honor  to 
those  whose  deeds  remain  unsung,  who  have 
labored  in  the  cause  of  science  without  hope  of 
applause. 

While  we  acknowledge  the  debt  we  owe  to 
Finlay,  who  suggested  that  the  mosquito  is  the 
infecting  agent  in  yellow  fever;  while  we  erect 
a  monument  to  Reed,  and  lay  a  wreath  upon 
the  grave  of  Lazear,  who  gave  us  the  proof; 
let  us  not  forget  the  pioneer  biologists  who 
studied  the  morphology  and  physiology  of  the 
mosquito,  and  who  were  called  unpractical. 
They  worked,  little  thinking  of  the  importance 
of  this  insect  to  human  life,  but  they  formulated 
and  made  accessible  their  knowledge,  sitting 
out  the  hours  in  the  laboratory  beside  the  faith- 
ful microscope,  and  dying,  never  to  hear  the 
word  "benefactor."  Until  the  bubonic  plague 
was  understood,  the  flea  was  an  unimportant  in- 
sect. But  science  now  takes  down  the  book  in 
which  is  written  the  biology  of  this  little  ani- 
mal, and  recognizes  as  human  benefactors  the 

206 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

men  who  studied  it  and  who  are  now  gone,  nn- 
thanked  for  their  service. 

Between  these  two  classes  of  earnest  men  is 
still  another :  those  who  belong  to  the  first  class 
but  have  failed.  Suppose  that  courageous  little 
woman  upon  whom  McDowell  operated  in.  the 
cabin  in  the  backwoods  of  Kentucky  had  died 
— such  a  result  has  occurred  in  less  serious 
cases  in  the  hands  of  men  of  even  greater  skill 
than  he — and  the  waiting  mob  had  destroyed 
the  surgeon,  the  name  of  McDowell  would  be 
practically  unlaiown  to  us;  and  yet  the  merit 
of  the  man  should  have  been  as  great.  Suppose 
that  O'Dwyer,  after  the  years  of  labor  to  per- 
fect his  intubation  tubes,  had  found  that  they 
failed;  he  would  have  been  the  same  meritori- 
ous O'Dwyer,  he  would  have  labored  just  as 
earnestly  for  mankind,  he  would  have  sacrificed 
as  much  for  them — ^yes,  more — ^but  there  would 
have  been  no  reward,  for  the  goal  would  not 
have  been  attained.  If  he  had  lived  to  this  day, 
he  would  see  the  usefulness  of  his  labors  almost 
made  null  by  the  invention  of  antitoxin ;  yet  the 
work  of  O'Dwyer  and  the  motives  that  inspired 
him  would  have  been  the  same.  Suppose  that 
Koch's  tuberculin  had  done  what  he  had  hoped 
it  would,  he  would  have  been  acclaimed  the 
15  207 


MEDICAL   SOCIOLOGY 

greatest  benefactor  of  his  time,  and  honors 
would  have  fallen  thick  and  fast  upon  him.  His 
hopes  were  not  realized,  but  shall  he  not  have 
honor  for  standing  upon  the  threshold  where 
he  could  not  enter  in  ?  The  work  he  did  and  the 
hopes  he  cherished  should  merit  it. 

Pasteur,  who  stands  preeminent  and  alone — 
his  genius  so  far  transcends  all  others — is  the 
greatest  and  most  beneficent  scientist  that  con- 
tinental Europe  has  produced.  (He  may  be 
spoken  of  in  the  present  tense,  because  if  ever 
there  was  an  immortal  man  it  is  Louis  Pasteur ; 
he  lives  in  every  laboratory  in  the  world  to-day 
where  original  biological  work  is  carried  on.) 
His  early  work  was  devoted  to  studying  the 
structure  of  crystals,  and  the  business  mind, 
which  demands  immediate  results,  declared  him 
an  "impractical  scientist."  But  the  study  of 
the  crystals  of  tartaric  acid  in  wine  lead  him  to 
the  discovery  of  the  cause  of  fermentation,  and 
thence  to  the  effects  of  microorganisms  upon 
living  things,  and  thence  to  bacteria  as  the 
causes  of  diseases,  and  thence  to  the  nature  and 
prevention  of  infections  and  the  principles  of 
antitoxins  and  immunity — the  most  important 
discoveries  into  the  nature  of  disease  which  it 
has  ever  been  given  to  any  man  to  make.    Had 

208 


MEDICAL   SCIEN'CE   AND   MEDICAL   ART 

his  researches  halted  with  crystallization,  the 
world  would  not  have  acclaimed  him  with  the 
glorious  title  of  benefactor;  but  undoubtedly 
from  his  beginnings  some  others  ultimately 
would  have  carried  on  the  train  of  thought  and 
investigation  as  far  as  he,  and  his  work  among 
the  crystals  would  have  counted  for  just  as 
much.  It  matters  not  to  humanity,  save  for 
pointing  an  example,  whether  its  great  work  is 
done  by  one  man  or  by  ten.  Nothing  is  lost. 
Who  adds  a  grain  of  knowledge  to  human  wis- 
dom is  a  benefactor.  Had  Pasteur  never 
reached  the  goal  of  glory,  still  he  should  have 
been  crowned  with  wreaths  of  victory,  for  he 
gave  his  life  to  the  task  of  wresting  Nature's 
secrets  from  her. 

All  honor  to  those  who  seek  for  knowledge; 
honor  to  those  who  enter  into  the  dark  and  un- 
explored realms  of  Nature ;  honor  to  those  who 
win  from  her  the  means  of  succor  for  the  dying 
and  relief  for  the  suffering ;  and  honor  still  to 
those  who  strive  and  strive  again  and  fail ! 

The  development  of  our  science  and  art  has 
been  an  evolutionary  process.  There  have  been 
no  great  discoveries  de  novo,  but  each  has  been 
the  culmination  of  a  series  of  efforts  mingled 
with  failures  and  successes.     Many  predeces- 

209 


MEDICAL    SOCIOLOGY 

sors  carried  the  torch  before  it  was  handed  to 
him  who  bore  it  to  the  goal  and  reaped  the  re- 
ward of  immortality.  All  honor  to  him  who 
thought  and  toiled — say  not  in  vain — and  died 
before  the  crowning  of  the  end.  He  might  have 
passed  on  this  message  from  Strode :  "  I  may 
never  take  you  farther  than  I  have  been  myself, 
but  you  may  press  on  when  I  tell  you  of  the 
vision  I  beheld.  You  may  never  fashion  from 
the  thing  I  wrought,  but  you  may  take  your 
reckoning  from  the  rare  design  where  my 
clumsv  hands  fell  short." 


II 

BACTERIOLOGY   AND   BOTANY 

THE  universality  of  medicine  is  displayed 
in  the  development  of  bacteriology. 
Here  is  a  department  of  human  knowl- 
edge which  belongs  to  botany;  but  who  would 
think  of  turning  to  the  botanist  for  information 
about  the  bacteria,  the  youngest  of  the  known 
floral  It  was  a  chemist,  Pasteur,  who  founded 
the  science  of  bacteriology;  and  straightway 
from  his  hands  it  passed  to  the  pathological 
anatomists  of  the  science  of  medicine.  Medi- 
cine has  developed  this  wonderful  field  of 
knowledge,  which  ramifies  into  nearly  all  of 
the  other  physical  sciences.  The  best  methods 
of  studying  the  bacteria,  their  life  history, 
their  classification,  the  means  of  cultivating 
them  artificially,  of  staining  and  differen- 
tiating them,  of  discovering  their  relations  to 
animals  in  health  and  disease,  have  all  been 
worked  out  in  the  medical  laboratories;  and, 
finally,  to  medicine  belongs  the  credit  of  study- 

211 


MEDICAL    SOCIOLOGY 

ing  and  discovering  their  biology,  the  char- 
acter of  their  excretions,  and  the  measures  for 
their  destruction.  Medicine  developed  the  sci- 
ence of  bacteriology,  and  out  of  it  evolved  most 
important  knowledge  for  the  saving  of  lives — 
the  knowledge  of  antitoxins  and  immunizing 
substances. 

Bacteriology  has  placed  upon  a  scientific 
basis  all  that  the  old-fashioned  common  sense 
called  cleanliness.  It  has  explained  the  myster- 
ies of  polluted  water.  It  has  defined  the  dan- 
gers of  dirt.  It  has  elucidated  the  etiology  of 
most  of  the  human  diseases.  It  has  even  dis- 
posed of  the  superstition  of  the  "  bleeding 
wafer."  It  has  taken  man  one  long  step  toward 
the  solution  of  the  problems  of  his  life. 

Medicine  has  not  only  enjoyed  the  education 
of  having  brought  this  science  to  its  perfection, 
but  it  has  had  the  satisfaction  of  seeing  it  taken 
up  by  the  chemist  and  the  agriculturist,  and 
turned  to  practical  ends  in  their  work.  But 
we  should  never  forget  that  the  bacteriologists, 
the  men  who  elaborated  this  subject  into  a 
science,  have  always  been  of  the  department 
of  pathology  of  the  science  of  medicine.  Bac- 
teriology grew  up  in  the  laboratories  of  the 
schools  of  medicine. 

212 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

Botany  lost  a  great  opportunity.  When  it 
was  revealed  that  the  bacteria  belonged  to  plant 
life  along  with  the  fungi,  botany  failed  to  step 
in  and  claim  its  own.  If  this  ancient  science 
had  been  as  industrious  in  studying  the  bi- 
ology of  plants  as  it  has  been  in  cataloguing 
them,  it  might  have  advanced  in  importance  to 
a  point  equal  to  that  of  zoology.  The  botanist 
has  failed  to  interest  himself  sufficiently  in  the 
fundamentals  of  his  science.  He  has  been  a 
catalogist ;  he  has  sacrificed  the  microscope  for 
the  herbarium;  he  has  not  been  so  much  inter- 
ested in  the  life  of  plants,  in  the  origin  and  fate 
of  plants,  as  in  their  family  trees.  The  botanist 
has  been  too  much  of  a  genealogist  and  too  little 
of  a  biologist.  He  has  interested  himself  too 
much  in  the  names  of  things,  and  too  little  in 
the  things  themselves. 

In  times  long  past  the  doctor  of  medicine,  in 
the  interest  of  his  peculiar  therapeutics,  was  a 
botanist.  Little  did  botany  dream  when  she 
let  him  in  at  the  back  door  to  dabble  in  her 
classified  herbs  and  witnessed  his  interest  grow 
less  and  less  that  after  a  few  centuries,  when 
apparently  he  had  become  most  neglectful,  he 
should  boldly  open  the  front  door  of  her  an- 
cient castle  and  walk  away  with  her  fairest 

213 


MEDICAL    SOCIOLOGY 

flower,  which  now  for  a  score  of  years  has 
adorned  the  gardens  of  the  sons  of  Sol. 

Bacteriology  in  twenty-five  years  has  had 
given  to  it  much  patient  research,  claiming  the 
sole  attention  of  more  devoted  men  than  have 
worked  at  botany  in  a  hundred  years.  Most  of 
these  men  are  unknown  to  the  world,  but  sev- 
eral hundred  of  them  have  contributed  equally 
to  the  development  of  this  science.  Botany  had 
her  great  lights,  some  of  the  greatest  men  that 
any  science  has  known.  They  have  been  but 
few,  but  they  were  all  great  men — Aristotle, 
Pliny,  John  Ray,  Linnaeus,  and  Asa  Gray. 

It  is  interesting  to  observe  that  three  of  these 
five  botanists  were  physicians,  and  two  of  these 
physicians  were  the  greatest  scientists  of  their 
respective  centuries.  But  the  greatness  of 
these  men  was  not  manifested  alone  in  botany, 
they  were  naturalists  and  pioneers  in  the  field 
of  zoology  as  well.  Had  they  been  living  at  the 
time  of  the  birth  of  bacteriology,  it  is  doubtful 
if  it  ever  would  have  departed  from  botany. 

But  the  parting  came.  Bacteriology  has 
grown  toward  humanity,  and  has  become  of  in- 
finite, practical,  everyday  usefulness  to  man- 
kind. Botany  is  still  the  aloof,  genteel,  sBsthetic 
science.     For  the  bacteriologist  the   suffering 

214 


MEDICAL    SCIENCE   AND   MEDICAL   ART 

and  dying  beckon  on.  For  the  botanist  the 
flowers  in  the  meadows  nod  their  heads,  the 
pine  trees  sing  softly  their  lullabies,  and  the 
breezes  of  summer  bear  upon  their  wings 
the  odors  of  the  wayside  vines. 


Ill 

SPONTANEOUS   GENERATION 

"Things  happening  to-day  are  merely  the  copy  and  reflex  of 
things  that  happened  in  former  times." 

NOW  and  then  some  one  goes  into  print 
with  the  statement  that  biology  and 
modem  medicine  are  founded  on  the 
thesis  that  life  does  not  originate  spontaneous- 
ly. It  is  interesting  to  encounter  the  dogmatic 
statement  that  modern  medicine  is  founded 
upon  this  assumption,  and  that  "  not  only  does 
no  living  thing  originate  except  from  preceding 
life,  but  no  portion  of  any  living  thing  comes 
into  being,  except  from  a  living  particle  of  the 
organism  of  which  it  is  to  form  a  part." 

If  there  is  any  one  thing  upon  which  modem 
biology  is  agreed,  it  is  that  there  was  a  time 
when  there  was  no  life  upon  the  earth,  and  that 
life  sprang  up  as  the  result  of  the  fortuitous 
conjunction  of  carbon,  hydrogen,  oxygen,  nitro- 
gen, sulphur,  and  phosphorus,  together  with 
moisture  and  heat.  Biologists  believe  that  the 
same  natural  laws  which  originally  combined 

216 


MEDICAL   SCIENCE   AND   MEDICAL  ART 

these  elements  into  protoplasm,  now  exist  and 
continue  to  operate.  While  no  one  has  suc- 
ceeded in  making  protoplasm  synthetically,  we 
do  know  that  it  was  once  made  in  the  great  lab- 
oratory of  Nature,  which  is  still  in  operation 
with  its  constant  and  immutable  laws.  No  biol- 
ogist contends  that  new  bacteria  or  nucleated 
cells  come  into  existence  spontaneously,  but, 
contrary  to  the  dogmatic  assertion  above  re- 
ferred to,  many  do  agree  that  living  matter, 
similar  to  that  from  which  the  bacteria  are  de- 
scended through  the  microphyta  and  microzoa, 
originates  spontaneously  and,  indeed,  is  origi- 
nating spontaneously  all  the  time.  The  cell 
which  Virchow  dealt  with  is  a  complex,  highly 
organized  form  of  life  compared  with  the  mo- 
nera  of  Haeckel  or  the  protoplasmic  slime  out 
of  which  they  spring. 

It  is  not  medicine,  but  rather  theology,  that 
is  founded  upon  the  proposition  of  an  early  and 
never-repeated  creation.  Because  plasmogeny 
is  not  susceptible  of  laboratory  demonstration, 
there  are  still  those  who,  according  to  F.  A. 
Lange,  "love  to  shelter  themselves  in  those 
dark  comers  which  science  has  not  yet  illu- 
mined with  its  rays,  and  there  to  hang  up  their 
cobwebs  to  catch  sound  reason  in." 

217 


MEDICAL    SOCIOLOGY 

The  monera  of  Haeckel  and  the  protoplasmic 
slime  found  in  the  sea,  which  biologists  are 
more  and  more  agreed  represent  the  simplest 
known  forms  of  living  matter,  have  never  been 
discovered  in  process  of  production,  because 
their  generation  took  place  or  takes  place  under 
conditions  with  which  we  are  not  familiar ;  but 
this  does  not  necessarily  hold  good  for  all 
time.  Geologists  have  never  discovered  the 
diamond  in  process  of  formation  in  nature. 
Artificial  chemistry  has  produced  organic  com- 
pounds which  had  previously  been  found  only 
as  a  part  of  living  organisms — urea,  alcohol, 
grape  sugar,  butyric  acid,  acetic  acid,  lactic 
acid,  fat,  amyloids,  and  alkaloids.  Chemistry 
is  steadily  approaching  the  production  of  pro- 
toplasm, although  it  will  be  most  difficult  to 
produce  artificially  the  albuminous  molecule, 
which  is  large  and  extremely  complex  in  struc- 
ture, its  atoms  being  held  in  very  unstable  com- 
bination. 

When  we  speak  of  spontaneous  generation 
the  modem  interpretation  does  not  call  for 
complex  organisms,  but  the  most  primitive 
plasmogenesis.  Other  interpretations  have 
long  since  passed  away.  Christendom  once  be- 
lieved   that    elephants    and    all    other    things 

218 


MEDICAL   SCIENCE   AND   MEDICAL  AET 

were  results  of  a  single  creative  act;  Harvey 
thought  mice  were  generated  spontaneously; 
Pasteur's  "  infinitely  small "  were  the  yeast 
organisms;  Virchow's  ultimate  organism  was 
the  cell ;  Haeckel  has  carried  us  to  the  monera ; 
and  a  host  of  modern  observers  are  at  work  in 
the  border  land  between  living  matter  and  the 
inorganic  world,  discovering  in  crystallization 
and  among  the  inorganic  molecules  activities 
closely  akin  to  those  of  so-called  organized  ma- 
terial. But  the  fact  that  the  chemist  has  not 
yet  succeeded  in  creating  protoplasm  or  be- 
cause the  biologist  has  not  yet  identified  it  in 
process  of  creation,  is  no  ground  to  assert  that 
spontaneous  generation  is  impossible  and  that 
the  laws  of  nature,  which  once  produced  living 
material,  are  no  longer  operative  in  that  direc- 
tion. 

The  plants  are  demonstrating  the  truth  of 
archegony.  The  chlorophyll  cell  possesses  the 
synthetic  power  of  plasmodomism  or  carbon  as- 
similation ;  it  builds  up  protoplasm  out  of  inor- 
ganic materials — water,  carbon  dioxide,  nitric 
acid,  and  ammonia.  Thus  in  the  laboratory  of 
the  plant  we  behold  the  construction  of  the  pro- 
toplasm, which  botanists  are  agreed  is  purely 
by  virtue  of  a  chemical  process.    The  plant  is 

219 


MEDICAL    SOCIOLOGY 

formed  of  inorganic  matter  and  can  be  resolved 
back  into  inorganic  matter. 

Max  Kassowitz,  in  his  "  Biologic,"  calls  atten- 
tion to  the  necessity  for  conceiving  of  the  de- 
velopment of  organic  from  inorganic  material 
as  requiring  an  incalculably  long  period,  and 
not  as  a  sudden  chemical  process.  But  that 
archegony,  or  spontaneous  plasmogeny,  does 
occur  is  pointed  to  by  nature  and  believed  by  a 
large  number  of  biologists. 

If  in  speaking  of  spontaneous  generation  one 
could  be  so  loose  in  the  use  of  language  as  to 
refer  to  cellular  organisms  alone,  such  as  bac- 
teria, then  we  must  say  that  most  agree  that 
bacteria  spring  from  bacteria;  but  no  one  fa- 
miliar with  the  great  principles  of  evolution 
would  dispute  that  new  and  ever-changing  va- 
rieties of  bacteria  are  developing  even  now  as 
a  result  of  natural  selection  and  the  laws  which 
lie  beneath  the  mutations  of  species. 


IV 

THE  BEGINNINGS   AND  PEOGBESS   OF   THEEAPEUTICS 

WHETHEK  we  think  of  man  as  the 
low-browed  primate,  as  the  warrior 
clothed  in  the  skins  of  animals,  or 
as  the  exalted  ruler  of  creation,  he  has  always 
sought  for  remedies  to  assuage  his  pains  and 
the  ills  of  his  flesh.  This  has  continued  to  be 
the  main  function  of  the  individual  practition- 
ers of  medicine,  notwithstanding  that  the  phi- 
losophers of  all  times  have  insisted  that  the 
highest  object  to  which  medicine  can  attain  is 
the  prevention  of  disease  and  the  prolonging 
of  life. 

The  treatment  of  diseases  began  long  before 
man  knew  the  nature  of  disease.  Then  came 
the  study  of  anatomy  and  physiology  and  path- 
ology, and  the  development  of  the  science  of 
medicine ;  but  therapeutics,  the  oldest  of  all  the 
branches  of  medicine,  has  always  attempted  to 
progress  faster  than  its  sister  branches  and 
keep  in  a  degree  independent  from  them,  thus 

221 


MEDICAL    SOCIOLOGY 

showing  its  primitive  origin.  There  always  has 
existed  a  disposition  to  try  remedies  for  dis- 
eases before  the  nature  of  the  disease  had  been 
studied,  or,  indeed,  before  the  nature  of  the 
remedy  was  known.  This  constitutes  the  em- 
piricism which  lies  at  the  base  of  therapeutics. 
And  somehow  or  other  there  crept  into  the 
mind  of  man  the  unfounded  notion  that  some- 
where in  the  world  there  was  a  remedy  for 
every  symptom  of  his  ailments.  To  this  add 
the  superstitions,  begotten  of  religion  and  cre- 
dulity, and  we  have  the  picture  of  the  humble 
origin  of  our  materia  medica.  The  employment 
of  drugs  and  chemicals  in  the  treatment  of  dis- 
ease began  too  early ;  it  would  have  been  better 
had  it  followed  rather  than  preceded  pathology. 
It  commenced  wrong.  It  began  at  the  target, 
and  not  at  the  bow ;  it  began  at  the  top,  and  not 
at  the  bottom,  as  all  well-founded  knowledge 
should. 

Our  modem  materia  medica  is  a  continuation 
of  fetichism,  down  through  alchemy  and  em- 
piricism. Its  brother  is  the  amulet.  It  is  but  a 
few  steps  in  human  progress  from  the  rust  of 
the  sword  that  killed  an  unbeliever  to  Blaud's 
pills;  from  the  powdered  tails  of  scorpions  to 
the  tincture  of  capsicum ;  from  the  decoction  of 

222 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

the  shells  of  the  eggs  of  a  dove  gathered  from 
the  cloister  wall  to  the  liquor  calcis  of  the  drug 
store.  Drugs  with  little  or  no  effect  gradually 
gave  way  to  those  which  had  a  denionstrable 
action;  and  we  have  our  materia  medica.  This 
development  has  been  through  empiricism. 

After  the  Middle  Ages  the  science  of  medicine 
developed  with  extraordinary  rapidity.  Much 
information  was  accumulated ;  new  truths  were 
discovered;  but  the  practical  application  of 
these  truths  to  therapeutics  was  unconscionably 
slow.  Yet  much  of  the  best  knowledge  that  we 
have  at  the  present  time  for  the  prevention  and 
treatment  of  diseases  was  then  in  the  posses- 
sion of  man. 

The  science  of  medicine  is  of  value  to  the  peo- 
ple only  as  it  is  brought  in  a  practical  way  to 
their  daily  needs,  and  this  administration  has 
rested  largely  in  the  hands  of  its  practitioners. 
Have  they  applied  most  wisely  and  practically 
the  knowledge  of  human  disease  which  has 
come  down  to  them  as  the  heritage  of  time  and 
which  the  patient  labors  of  thousands  of  ear- 
nest men  have  won!  Were  it  possible  for  us  to 
project  our  vision  backward  into  the  past  for 
so  short  a  period  as  a  hundred  years  we  should 
witness  in  the  medical  administrations  of  that 
16  223 


MEDICAL    SOCIOLOGY 

day  such  therapeutics  as  would  convince  us  that 
the  fetichism  of  drugs  survived  still  in  the  very 
presence  of  scientific  medical  knowledge.  And 
what  of  to-day?  Have  we  any  compunctions  as 
to  what  the  historian  shall  see  when  he  projects 
his  vision  backward,  a  hundred  years  from 
now,  upon  us?  I  fear  we  have.  What  is  the 
present  status  of  our  medical  therapeutics? 

The  young  man  who  graduated  during  the 
past  century,  or  I  may  say  during  the  present, 
was  sent  out  into  the  world  to  practice  medicine 
with  the  impression  that  drugs  are  the  main  re- 
liance of  therapeutics.  His  professor  of  thera- 
peutics was  also  professor  of  materia  medica; 
and  his  mind  was  trained  so  that  when  the 
treatment  of  disease  was  mentioned  he  at  once 
thought  of  the  particular  drugs  that  were  in- 
dicated. Text-books  upon  therapeutics  exhibit 
two  different  arrangements:  one  gives  the  de- 
scription of  the  drugs,  and  then  follows  this 
with  the  diseases  in  which  they  are  indicated; 
the  other  gives  diseases  or  symptom  groups, 
and  follows  this  with  the  drugs  to  be  used.  The 
combination  of  drugs  with  therapy  is  so  close 
that  the  student  cannot  escape  it.  And  yet,  be- 
yond and  outside  of  all  of  this,  lies  the  great 
field  of  therapeutics  only  just  beginning  to  re- 

224 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

ceive  the  scientific  attention  to  which  its  im- 
portance entitles  it. 

The  chair  of  materia  medica  and  therapeutics 
should  be  divided.  Materia  medica  should  take 
its  place  where  it  belongs  in  the  department  of 
chemistry.  The  science  of  the  treatment  of  dis- 
eases should  be  put  along  with  the  teaching 
of  the  pathology  and  symptomatology,  or  else 
made  a  separate  branch  of  the  teaching  of  the 
practice  of  medicine.  The  teacher  of  medical, 
or  nonsurgical,  therapeutics  should  become  one 
of  the  most  important  adjuncts  to  the  faculty 
of  medicine.  He  should  have  to  do  with  the  ra- 
tional treatment  of  diseases.  He  should  not 
teach  "  sectarian  medicine,"  the  treatment  by 
drugs  alone.  He  should  roam  all  the  fields  of 
every  art  and  science,  and  take  the  best  they 
have  to  offer.  His  therapeutics  should  be 
founded  on  physiology  and  pathology,  not  on 
chemistry  and  botany.  He  should  teach  the 
student  how  to  treat  a  sick  person,  not  what 
drugs  to  give  in  certain  diseases. 

The  man  who  knows  the  history  of  his  race 
knows  that  homeopathy,  osteopathy.  Christian 
science,  and  the  kindred  delusions,  would  not 
have  secured  the  following  they  have  unless 
they  had  something  to  offer.    If  this  is  anything 

225 


MEDICAL    SOCIOLOGY 

that  can  be  employed  in  the  treatment  of  dis- 
eases, it  is  the  business  of  the  scientific  thera- 
peutist to  find  it  out  and  let  us  have  it.  We 
have  had  to  learn  for  ourselves  that  homeop- 
athy taught  the  healing  power  of  nature;  our 
professor  of  therapeutics  did  not  tell  us.  The 
old-time  doctor  saw  patients  recover  under  the 
administrations  of  the  homeopath  without  their 
taking  any  appreciable  medication.  There  was 
not  much  difference  between  the  mortality  in 
his  practice  and  that  of  his  homeopathic  neigh- 
bor. It  was  a  valuable  knowledge  to  acquire, 
that  a  sick  man  might  get  along  pretty  well 
without  any  drugs;  and  we  have  to  thank  the 
homeopathic  delusion  for  teaching  it.  Unfor- 
tunately, or  fortunately,  as  the  case  may  be, 
apostasy  has  overtaken  the  disciples  of  this 
particular  cult,  and  they  have  become  addicted 
to  the  administration  of  drugs  to  such  a  degree 
that  we  are  quite  deprived  of  further  opportu- 
nities of  observing  in  their  practice  the  phe- 
nomena of  the  vis  medicatrix  naturce. 

Christian  science,  founded  upon  unreason, 
teaches  us  the  value  of  the  influence  of  mind 
over  certain  mental  illnesses.  It  has  demon- 
strated this  in  a  practical  manner;  and  the 
therapeutist  who  ignores  it  is  not  wise.    Chris- 

226 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

tian  science  is  a  demonstration  of  the  power 
of  optimism.  It  also  teaches  that  the  natural 
tendency  of  most  diseases  is  toward  recovery. 
Because  the  good  in  it  is  wrapped  in  the  warp 
and  woof  of  ignorance  and  superstition  does  not 
make  it  any  the  less  good  or  available,  any  more 
than  morphine  or  iodine  should  not  be  prized 
because  they  are  found  in  nature  associated 
with  noxious  and  inert  materials.  Osteopathy, 
a  combination  of  massage,  ignorance,  and  char- 
latanism, is  adding  further  proofs  of  the  healing 
power  of  nature  and  of  the  value  of  massage 
and  passive  motion  in  certain  chronic  dis- 
eases. Whether  these  therapeutic  fads,  which 
proceed  to  treatment  without  knowledge  of  the 
pathologic  anatomy  of  diseases,  do  more  harm 
than  good,  I  shall  not  now  attempt  to  discuss ; 
but  that  they  do  teach  valuable  lessons  to  medi- 
cine cannot  be  gainsaid. 

If  the  therapeutist  wished  evidences  of  the 
natural  tendency  of  diseases  to  heal  themselves, 
he  need  not  go  to  these  pseudo-sciences  and  to 
quackery  for  proofs.  He  may  find  them  in  the 
legitimate  practice  of  medicine.  He  may  see 
the  apparent  success  enjoyed  by  many  a  legal- 
ized practitioner  whose  knowledge  of  medicine 
can  scarcely  come  under  the  head  of  knowledge. 

227 


MEDICAL   SOCIOLOGY 

We  have  arrived  at  the  threshold  of  the 
institution  of  rational  therapeutics.  We  were 
not  taught  it  in  our  student  days,  but  now  we 
are  learning  that  drugs,  excepting  the  antitox- 
ins and  a  score  of  products  of  the  laboratory, 
have  a  very  subordinate  place  in  the  treatment 
of  the  diseases  in  which  the  mortality  is  being 
lowered.  In  a  recent  paper,  W.  M.  Barton 
{Jour.  Am.  Med.  Assoc,  vol.  lii,  No.  20)  cites 
the  following  instances  of  pharmacologic  fetish- 
ism :  olive-oil  and  gall-stones,  valerian  and  hys- 
teria, tannic  acid  and  internal  hemorrhage,  al- 
cohol and  ether  injected  in  shock,  colchicum 
and  gout,  potassium  iodid  and  sclerosis,  chlorate 
of  potassium  and  stomatitis,  the  hypophos- 
phites  and  neurasthenia,  lithium  and  uric  acid 
diathesis,  and  calcium  salts  and  internal  hem- 
orrhage. 

With  our  professor  of  materia  medica  drugs 
were  the  first  consideration  in  the  intestinal 
diseases  of  infancy,  in  phthisis,  typhoid  fever, 
the  exanthemata,  appendicitis,  erysipelas,  and 
pneumonia;  and  now  how  small  a  figure  they 
play  in  the  treatment  of  these  conditions;  be- 
cause rational  therapeutics  has  developed  out 
of  the  study  of  their  pathology. 


THE    KATIONALIZATION    OF    THERAPEUTICS 

OUTSIDE  of  the  drug  store  are  many 
valuable  remedies.  More  important 
than  drugs  in  the  treatment  of  diseases 
are  fresh  air,  smishine,  cleanliness,  proper 
clothing,  proper  eating,  proper  breathing,  good 
morals,  temperance,  equanimity,  kindness,  self- 
reliance,  exercise,  rest,  occupation,  the  care  of 
the  mind,  the  training  of  the  child,  high  ideals, 
knowledge  of  hygiene,  optimism,  and  cheerful- 
ness. It  is  the  absence  of  these  that  has  caused 
most  ills,  and  they,  instead  of  drugs,  should 
have  the  first  consideration  in  the  treatment. 
How  little  really  well-formulated  knowledge 
we  have  of  these  vital  things  compared  with 
our  well-formulated  knowledge  of  the  uses  of 
drugs.  The  charlatan  often  steps  in  and  mas- 
ters one  of  these  subjects,  and  scores  a  triumph 
over  the  doctor  of  medicine. 

I  have  seen  a  man  dying  with  pneumonia  in 
a  room  so  close  that  the  nurse  had  a  perpetual 

229 


MEDICAL    SOCIOLOGY 

headache,  but  the  poor  man  was  taking  oxygen 
from  the  drug  store.  Why?  Because  the  use 
of  oxygen  from  the  drug  store  was  taught  by 
the  professor  of  materia  medica  and  therapeu- 
tics, but  not  the  use  of  the  oxygen  of  the  free 
and  open  air  which  can  be  secured  without  the 
mystic  scroll  which  means  recipe. 

The  teaching  of  the  patient  about  his  disease 
so  that  he  may  cooperate  with  the  doctor  is 
often  necessary  for  successful  treatment.  The 
doctor's  life  in  the  future  is  going  to  present 
even  more  responsibilities  than  it  ever  has.  The 
time  is  approaching  when  he  must  give  more  of 
his  personal  attention  to  the  sick.  He  shall  not 
escape  his  duty  by  dashing  off  a  prescription, 
and  leaving  the  rest  to  nature  and  the  druggist. 
He  is  becoming  too  useful  and  too  learned  a  man 
for  such  shirking  of  responsibility.  In  this 
work  the  trained  nurse  and  the  assistant  to  the 
doctor  are  destined  to  play  an  important  role. 
There  are  directions  to  be  carried  out  and  in- 
structions to  be  given,  and  an  in-touchness  with 
the  patient  to  be  maintained,  which  can  best  be 
done  through  the  agency  of  such  assistance. 

The  foundation  of  therapeutics  is  in  pathol- 
ogy, etiology,  and  diagnosis.  The  physician 
must  get  at  the  root  and  the  cause  of  the  mal- 

230 


MEDICAL   SCIENCE   AND    MEDICAL   ART 

ady  before  he  can  treat  it  intelligently.  Next, 
he  must  eliminate  the  cause;  and  when  he  has 
done  this  he  has  progressed  so  far  in  the  treat- 
ment that  the  cure  is  usually  in  sight.  There 
is  many  a  doctor  who  stands  well  in  his  profes- 
sion, whose  waiting  room  is  crowded,  and  who 
gives  only  sufficient  attention  to  each  case  to 
ask  a  few  hasty  questions,  write  a  prescription, 
and  say,  "  Take  this,  and  let  me  see  you  again 
one  week  from  to-day."  The  chances  are  that 
the  patient  will  be  better,  but  the  wise  man 
knows  that  this  physician  has  not  stood  in  the 
proper  position  in  the  tableau  of  doctor  and 
patient.  Already  the  doctor's  duty  to  the  man 
with  consumption  is  no  longer  ended  with  a  pre- 
scription for  cod-liver  oil  and  creosote.  This 
evolution  we  have  witnessed  in  the  last  few 
years. 

The  new  therapeutics  demands  of  the  physi- 
cian that  when  a  patient  comes  complaining  of 
a  headache  she  shall  not  be  dismissed  with  a 
prescription  for  a  drug,  but  that  the  cause  of 
the  complaint  shall  be  determined  and  the  stuffy 
bedroom  in  which  she  sleeps  shall  be  flooded 
with  fresh  air  day  and  night.  When  a  patient 
seeks  help  for  his  loss  of  appetite  he  shall  not 
be  cast  aside  with  a  prescription  for  a  bottle 

231 


MEDICAL    SOCIOLOGY 

of  mix  and  gentian,  but  the  cause  shall  be  dis- 
covered, and  he  shall  have  prescribed  for  him 
a  walk  to  his  office  instead  of  a  ride,  instruc- 
tions in  deep  breathing,  and  an  omission  of  the 
preprandial  cocktail.  When  the  doctor  is  con- 
sulted for  the  pain  in  the  leg  of  a  child,  he  shall 
not  have  fulfilled  his  duty  by  sending  the  parent 
to  the  drug  store  for  salicylic  acid,  but  he  shall 
learn  the  cause  of  the  pain,  and  upon  determin- 
ing that  it  is  coxitis,  apply  the  rational  treat- 
ment. Therapeutics  is  becoming  something 
more  than  a  few  encouraging  words  and  a  bot- 
tle of  medicine. 

The  old  therapeutics  kept  the  children  with 
tuberculosis  of  bones  and  joints  in  the  hospital 
ward  where  they  might  not  be  cold,  and  de- 
pended upon  treating  them  with  hypophos- 
phites  and  cod-liver  oil,  while  abscess  after 
abscess  was  evacuated.  The  drugs  are  now 
omitted,  and  the  children  are  put  out  in  the 
fresh  air  and  sun,  anywhere — on  the  roof,  in 
the  garden,  on  the  balcony — and  there  are  fewer 
abscesses  to  open. 

Most  diseases  are  preventable,  and  most  dis- 
eases will  subside  when  the  cause  is  removed. 
Consumption  is  a  product  of  a  combination  of 
the   violations  of   the  laws   of  natural  living 

232 


MEDICAL   SCIENCE   AND   MEDICAL   AKT 

which  we  boastfully  designate  by  the  name  of 
civilization.  The  only  treatment  that  is  suc- 
cessful is  no  treatment  at  all,  for  it  simply  con- 
sists in  taking  the  patient  out  of  the  pernicious 
and  unnatural  environment  in  which  he  con- 
tracted the  disease  and  compelling  him  to  live 
naturally ;  that  is,  in  the  open  air,  and  on  simple 
and  nourishing  food.  Had  he  lived  this  way 
before,  he  would  not  have  had  consumption.  In 
all  the  practice  of  medicine  there  is  no  more 
pitiful  sight  than  that  of  a  doctor  who  should 
know  better  dealing  out  pills  to  a  patient  who 
needs  to  be  told  how  to  live ;  and  m  all  the  prac- 
tice of  medicine  there  is  no  more  glorious  sight 
than  that  of  a  doctor,  who  knows  how,  prevent- 
ing the  developing  of  a  disease  or  discovering 
and  removing  the  cause. 

One  of  the  greatest  needs  of  medicine  to-day 
is  a  scientific  formulation  of  the  old  knowledge. 
Let  us  formulate  and  put  upon  a  scientific  work- 
ing basis  the  important  things  which  involve 
the  everyday  life. 

Some  children  sleep  with  their  windows  open 
summer  and  winter,  or  sleep  out  of  doors,  and 
are  the  ideals  of  health.  Others  sleep  with  their 
windows  closed,  and  look  sickly  and  often  are 
sick.    Which  is  better?    Are  these  observations 

233 


MEDICAL    SOCIOLOGY 

only  exceptions  which  have  some  other  explana- 
tion, or  are  they  worthy  to  be  studied  and  for- 
mulated; and  should  we  not  be  as  well  agreed 
upon  this  subject  as  we  are  upon  the  action  and 
uses  of  strychnine? 

Treves  has  emphasized  the  beneficence  of  dis- 
eases, and  he  has  gone  so  far  as  to  allege  that 
we  should  all  have  been  dead  long  ago  had  it 
not  been  for  diseases.  This  is  not  offered  in 
a  spirit  of  waggery,  implying  that  we  live  by 
diseases ;  for  in  this  flippant  sense  it  would  al- 
ways have  to  be  left  to  some  one  else  to  do  the 
suffering.  That  is  the  idea  promulgated  by  the 
humorist  who  said  that  the  best  place  to  have 
a  carbuncle  is  on  the  back  of  the  neck  of  some- 
body else.  What  Treves  refers  to  is  that  the 
symptoms  of  disease — the  pathologic  changes 
of  disease — are  but  a  manifestation  of  an  ef- 
fort on  the  part  of  the  body  to  rid  itself  of 
some  offending  and  harmful  foreign  substance. 
Whether  it  is  bacteria,  ptomaines,  or  cucumbers 
that  are  causing  the  trouble,  the  symptoms  are 
but  an  evidence  of  a  salutary  effort  of  the  or- 
ganism to  rid  itself  of  the  noxious  invader. 
Peritonitus  has  saved  more  lives  than  "  all  the 
drowsy  sirups  of  the  East " ;  but  we  should  not 
lose  sight  of  the  fact  that  the  drowsy  sirups 

234 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

of  the  East  may  sometimes  be  used  to  supple- 
ment the  salutary  action  of  peritonitis  and  help 
save  life. 

The  effects  of  drugs  fall  into  the  same  cate- 
gory, along  with  the  ptomaines  and  cucumbers. 
The  so-called  physiological  actions  of  drugs  are 
the  symptoms  of  an  effort  of  the  system  to 
throw  off  an  offending  foreign  substance,  or 
they  are  an  e\ddence  of  the  system  being  over- 
come by  this  same  substance.  They  represent 
reaction  to  foreign  material.  Fortunately,  many 
of  the  drugs  can  be  made  to  supplement  disease 
in  stimulating  the  activities  of  the  natural 
forces  of  the  body,  and  thus  have  a  salutary 
action  in  hastening  the  elimination  of  the  dis- 
ease. Undigested  and  irritating  material  in 
the  intestine  is  productive  of  increased  peri- 
stalsis and  a  flow  of  serum  into  the  bowel.  Cas- 
tor oil  produces  similar  results,  and  therefore 
is  useful  in  aiding  Nature  in  her  effort  to  elimi- 
nate the  cause  of  the  disease.  The  antitoxins  are 
employed  as  synergists  to  the  natural  healing 
powers  of  the  body,  and  accordingly  are  of 
much  value.  The  objectionable  drugs  are  the 
inert  drugs,  those  which  do  actual  harm,  and 
those  which  detract  attention  from  more  im- 
portant things. 

235 


MEDICAL    SOCIOLOGY 

The  medical  profession  has  fostered  it,  and 
upon  the  medical  profession  devolves  the  duty 
of  curing  the  public  of  its  drug  addiction.  The 
physician  least  learned  in  the  nature  of  dis- 
eases is  the  one  most  given  to  the  employment 
of  drugs.  They  are  the  lazy  man's  expedient. 
The  educated  physician  gives  drugs  often  to 
relieve  immediate  conditions  or  to  induce  com- 
fort while  he  corrects  the  cause,  and  patiently 
waits  for  nature  to  cure  the  disease.  But  when 
he  gives  medicine  as  a  placebo  he  is  placing 
his  stamp  of  approval  upon  a  practice  which  he 
knows  is  wrong.  The  American  public  takes 
$75,000,000  worth  of  patent  medicines  yearly. 
Who  taught  them  that  the  remedy  for  illnesses 
is  drugs'?  And  who  but  the  medical  profession 
indorsed  the  use  of  drugs  as  the  sovereign  rem- 
edy for  disease  ?  But  now  as  rational  therapeu- 
tics advances,  and  we  are  placing  less  depend- 
ence on  drugs,  the  charlatan  keeps  up  with 
the  procession.  The  medicine  quack  is  being 
succeeded  by  the  "  food  expert,"  the  "  physical- 
health  instructor,"  the  "  breathing  expert,"  and 
others,  all  who  claim  that  they,  too,  have  ad- 
vanced beyond  therapy  by  drugs. 

A  journal  devoted  to  the  interests  of  osteop- 
athy has  recently  gone  through  Osier's  works 

236 


MEDICAL   SCIETs^CE   AND   MEDICAL   ART 

and  culled  out  the  instances  in  wMch,  in  speak- 
ing of  treatment,  he  has  not  advised  the  employ- 
ment of  drugs  or  has  said  that  there  is  no 
known  internal  remedy  that  is  of  service  in  in- 
fluencing the  course  of  the  disease.  The  list 
of  diseases  is  a  rather  large  one ;  and  the  infer- 
ence is  that  because  Osier  does  not  advise  any 
particular  drugs  in  their  treatment,  they  are- 
without  the  pale  of  medicine.  The  rational 
view  should  be  that  if  honest  investigation 
shows  that  drugs  do  not  influence  these  dis- 
eases so  much  the  worse  for  the  drugs  and  so 
much  glory  for  the  investigator.  Medicine  does 
not  live  by  drugs  alone. 

The  very  name  of  our  profession  is  an  un- 
fortunate one.  It  is  outgrowing  medicine  and 
is  taking  its  place  as  the  science  of  sanitation, 
of  hygiene,  of  health.  Medicine  began  by  ef- 
forts to  make  the  sick  well:  to  that  it  has 
added  its  efforts  to  preserve  the  well  in  health. 
Sanitary  science  is  what  modern  medicine 
means,  and  sanitary  science  is  what  it  should 
be  called. 

It  has  been  ruled  by  courts  in  several  in- 
stances that  the  practice  of  medicine  consists  in 
administering  drugs,  and  that  if  no  medicine 
is  given  it  is  not  the  practice  of  medicine.    A 

237 


MEDICAL    SOCIOLOGY 

broader  interpretation  has  been  placed  upon 
this  subject  by  the  courts  in  some  States.  The 
law  in  many  States,  however,  allows  an  irregu- 
lar practitioner  to  see  a  case  of  typhoid  fever 
through  his  disease,  and  calls  him  blessed,  pro- 
vided he  does  not  give  any  medicine ;  and  yet, 
cases  of  typhoid  fever  are  recovering  every  day 
in  our  hospitals  without  having  received  a  drop 
of  medicine. 

If  we  could  imagine  that  for  fifty  years  the 
manufacture  and  internal  medical  use  of  ninety 
per  cent  of  the  drugs  now  employed  were  dis- 
continued, it  is  conceivable  that  therapeutics 
would  advance  to  a  position  which  it  now  will 
take  more  than  a  century  to  attain.  Therapeu- 
tic measures  and  hygiene,  now  neglected,  would 
be  seized  upon,  and  when  fifty  years  had  rolled 
round  we  should  be  surprised  to  find  how 
poorly  we  prized  our  old  friends  of  the  apothe- 
cary shop,  and  how  well  the  practice  of  medi- 
cine had  prospered  without  them.  If  there  were 
no  quinine  or  arsenic  for  malaria  we  should  ex- 
ert our  energies  in  a  campaign  of  extermination 
against  the  mosquito.  While  the  drugless  treat- 
ment of  consumption  has  accomplished  splendid 
results  in  reducing  the  mortality  from  that  dis- 
ease, still,  its  greatest  value  has  been  in  teach- 

238 


MEDICAL   SCIENCE   AND    MEDICAL   AET 

ing  people  how  to  live.  Its  best  value  is  to  the 
nonconsumptive.  However,  I  do  not  suggest 
the  discontinuance  of  the  use  of  potent  and  val- 
uable remedies ;  I  make  these  statements  to  call 
attention  to  the  other  and  more  important  side 
of  therapeutics. 

I  would  not  be  understood  to  advocate  drug 
nihility,  for  the  plants  and  the  minerals  and  the 
laboratory  furnish  invaluable  therapeutic  aids ; 
but  I  do  insist  that  rational  therapeutics  begins 
with  pathology  and  prophylaxis  and  the  res- 
toration of  physiological  conditions,  and  that 
medicine  has  too  slowly  grasped  the  simple  and 
natural  principles  of  therapeutics. 

The  therapeutic  aids  of  the  greatest  value 
are  the  simplest  and  cheapest  and  most  access- 
ible. Most  of  the  illnesses  against  which  treat- 
ment is  aimed  are  due  to  violations  of  right  liv- 
ing. To  restore  the  patient  to  normal  living 
is  treatment  of  double  scientific  value :  it  offers 
cure  for  the  present  and  prevention  for  the  fu- 
ture. Let  us  felicitate  ourselves  that  in  our  day 
we  have  witnessed  the  dawn  of  the  new  thera- 
peutics and  the  decadence  of  the  fetichism  of 
drugs. 


17 


VI 


THE    FATE    OF    MEDICINE 

THE  medical  profession  is  engaged  in  car- 
rying on  a  propaganda  of  destruction  of 
the  necessity  for  its  own  existence.  It 
lives  by  the  presence  of  the  diseases  which  it  is 
striving  to  make  extinct.  As  a  business  it  puts 
aside  business  principles;  as  a  profession  it  is 
the  most  beneficent  force  at  work  at  the  present 
time  for  the  improving  of  the  condition  of 
human  life.  If  it  were  a  business,  it  could  prop- 
erly say:  "We  will  make  ourselves  as  compe- 
tent as  possible  to  heal  your  diseases  if  phys- 
ical misfortune  overtakes  you  or  if  you  are  so 
foolish  as  to  make  yourself  sick."  That  would 
certainly  be  a  laudable  enterprise,  and  the  phy- 
sician would  thrive  beyond  the  thrift  of  the 
butcher  or  baker  or  banker. 

If  medicine  were  a  business  and  the  medical 
profession  were  a  trust,  the  plague  and  small- 
pox and  cholera  and  diphtheria  would  be  rife 
and  feeding  fat  the  doctor's  wallet.    But  one 

240 


MEDICAL   SCIENCE    AND   MEDICAL   ART 

by  one  medical  men  have  learned  the  causes  of 
the  diseases  and  applied  the  means  of  preven- 
tion. Much  thankless  toil  and  labor  this  has 
cost.  The  medical  profession  has  not  only  dis- 
covered the  life-saving,  preventive  measures, 
but  it  has  begged  and  pleaded  with  the  people 
to  accept  them.  It  has  humiliated  itself  be- 
fore legislatures,  it  has  appealed  to  govern- 
mental authorities,  it  has  spent  its  substance 
in  the  education  of  the  people,  it  has  labored 
with  the  individual  for  the  sake  of  his  own 
health,  it  has  taught  the  mother  how  to  save 
her  babies  from  sickness — and  all  the  while  tak- 
ing the  bread  from  the  mouths  of  its  own 
children. 

Now,  more  than  at  any  time  in  history,  med- 
icine is  laboring  so  successfully  in  the  interest 
of  the  prevention  of  diseases,  and  the  great 
value  of  this  work  is  becoming  so  well  appre- 
ciated, that  we  are  confronted  with  new  condi- 
tions and  possibilities  of  metamorphosis  of 
medical  activity.  We  are  at  the  beginning 
of  the  time  when  preventive  medicine  shall  be 
something  more  than  an  exceptional  benison; 
we  have  arrived  at  the  time  when  the  actual 
practice  of  preventive  medicine  will  be  pursued 
with  all  the  activity  which  the  ancient  physi- 

241. 


MEDICAL    SOCIOLOGY 

cians  applied  to  the  so-called  healing  of  dis- 
eases. 

We  may  properly  ask  the  question,  To  what 
is  this  leading?  MHiat  is  to  be  the  fate  of  the 
medical  profession?  And  the  answer  is  plain 
to  one  who  has  read  clearly  the  history  of  his 
race,  and  who  has  faith  and  hojDC  in  the  destiny 
of  man.  The  tendency  of  the  medical  profes- 
sion is  toward  its  own  obliteration.  Let  ns  be 
thankful  that  this  is  true,  for  this  is  the  spark 
that  vivifies  it  and  makes  us  know  that  it  is  a 
living  thing.  All  that  is  in  process  of  evolution 
upward  must  lose  itself  and  disappear.  All 
that  truly  lives  must  die  into  something  else. 
The  dead  rock  endures  unchanged  for  ages,  but 
man  dissolves  himself  into  mankind  and  dies. 

"When  I  speak  of  the  obliteration  of  the  med- 
ical profession  I  do  not  speak  with  the  tongue 
of  the  prophet,  who  sees  unto  the  very  end,  but 
rather  with  the  insight  which  discovers  the 
steady  workings  of  that  great  evolutionary 
force  which  day  by  day,  '^  Ohne  Hast,  ohne 
Rast,"  sees  the  diminishing  necessity  for  the 
doctor.  This  is  the  reason  why  he  is  entitled 
to  the  designation  Doctor.  The  true  mission  of 
the  teacher  is  to  lead  his  pupil  to  the  goal  where 
he  can  be  independent  of  him.    Emerson  has 

242 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

said  that  the  state  exists  for  the  purpose  of 
making  men  wise,  and  when  all  men  have  be- 
come wise  the  state,  or  government,  will  have 
no  excuse  for  existence  and  will  cease. 

Medicine  is  a  noble  profession  because  her 
sons  are  entitled  to  this  title  of  Doctor.  We 
should  guard  it  jealously.  Doctor  means  teach- 
er. It  is  one  of  the  two  great  titles.  The  other 
is  Mother.  The  Teacher  and  the  Mother  have 
a  similar  mission.  It  is  to  make  those  who  look 
to  them  for  succor  independent  of  them.  Each 
is  working  toward  the  weaning  of  its  charge. 
The  mother  duty  is  to  nourish  and  train  and 
guide  the  child  toward  the  day  when  it  may  be 
independent,  and  thrive  as  well  without  her. 
If  she  fail  in  this  she  fails  in  her  highest  duty. 
The  function  of  the  teacher  is  the  same.  The 
goal  toward  which  he  leads  his  pupil  is  to  make 
the  pupil  possessed  of  his  knowledge  and  the 
benefits  of  his  talents.  The  true  teacher  with- 
holds no  secret  of  his  profession.  He  gives  all. 
He  strives  to  make  his  pupil  perfect,  even  as 
himself.  He  makes  the  pen  with  which  the  pu- 
pil writes  his  emancipation.  If  he  fail  in  this 
he  has  not  taught  well. 

As  the  mother  is  to  the  child  so  is  the  medi- 
cal profession  to  all  mankind.    It  is  slowly  but 

243 


MEDICAL   SOCIOLOGY 

inevitably,  with  beneficent  purpose  and  with 
lofty  aim,  abdicating  the  necessity  for  its  own 
existence.  Whether  the  complete  abdication  will 
ever  be  attained,  no  man  can  say ;  the  important 
fact  is  the  goal  toward  which  we  aim. 


VII 

THE    FUTURE    FIELDS    OF    MEDICAL   ACTIVITY 

DURINGr  the  evolutionary  progress  of 
medicine  there  will  always  be  an  im- 
portant mission  for  the  doctor.  He 
will  have  less  and  less  to  do  with  the  care  of  the 
sick  and  more  and  more  with  the  prevention  of 
sickness.  When  the  relative  proportion  of  doc- 
tors becomes  less,  the  importance  of  the  individ- 
ual doctor  should  become  greater.  One  physi- 
cian as  sanitary  commissioner  at  the  head  of  a 
community  can  prevent  an  epidemic  of  typhoid 
fever  which  would  demand  the  activities  of  a 
thousand  physicians  once  it  is  started.  The 
physician,  exercising  the  preventive  function, 
is  to  be  the  important  man,  not  only  as  the 
community  adviser,  but  as  the  family  and  in- 
dividual adviser  as  well.  Common  sense  and 
the  present  tendency  of  scientific  work  declare 
that  it  is  better  to  exercise  endeavors  to  prevent 
disease  than  to  cure  it.  It  is  cheaper  to  keep 
one  man  constantly  on  guard  to  prevent  the 

245 


MEDICAL    SOCIOLOGY 

spark  from  striking  the  tinder,  than  to  summon 
a  thousand  in  the  hour  of  distress  to  save  the 
burning  citadel. 

The  fields  of  activity  of  the  medical  profes- 
sion are  destined  to  be,  in  national  and  state 
councils  and  executive  offices,  safeguarding  the 
health  of  the  people ;  in  the  more  intimate  rela- 
tions with  the  public  in  county  and  municipal 
health  offices;  and  in  the  personal  relations  of 
teacher,  family  physician,  consultant  and  spe- 
cialist. 

And  some  day  the  wise  man  will  attach  the 
physician  to  his  family,  not  to  cure  diseases  but 
to  prevent  them.  As  a  business  matter  it  will 
be  more  economic.  One  of  our  greatest  social 
absurdities  is  permitting  people  to  become  sick 
and  then  employing  a  doctor  to  get  them  well. 
It  is  the  largest  of  all  of  the  preventable  wastes. 
We  are  prodigal  of  nothing  to  so  great  a  degree 
as  we  are  of  our  health.  That  is  our  greatest 
national  extravagance.  In  that  we  find  the  chief 
waste  of  natural  resources. 

Health  is  too  important  a  thing  to  be  made 
subject  to  the  rules  of  trade  and  commerce. 
When  the  average  man  is  taken  sick  he  then 
employs  a  doctor  to  help  him  recover.  The 
doctor  is  placed  in  the  unfortunate  position  of 

246 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

depending  upon  the  morbidity  of  others  for  his 
livelihood,  and  the  patient  is  placed  in  the  un- 
fortunate position  of  having  his  misfortune  be- 
come the  doctor's  advantage.  This  system 
works  hardship  to  both  parties.  A  better  state 
of  civilization  will  demand  that  the  physician 
be  regarded  as  a  public  necessity,  and  that  each 
community  shall  have  competent  medical  men, 
with  assured  incomes,  the  same  as  health  offi- 
cers, paid  by  the  public.  The  better  the  state 
of  health  the  physicians  can  maintain  in  their 
districts,  the  greater  should  be  their  emolument 
— ^not  the  less,  as  it  now  is.  Every  person 
should  have  easy  access  to  skillful  and  scien- 
tific medical  services,  not  as  a  matter  of  charity, 
but  as  a  matter  of  right.  The  charlatan  would 
not  thrive  under  such  conditions.  A  policeman 
is  now  assigned  to  a  certain  district  to  prevent 
and  correct  violations  of  the  law.  Health  should 
receive  the  same  consideration  as  property  does. 
That  the  people  of  this  great  country  are  to 
have  a  national  department  of  health,  there  is 
no  doubt.  Such  a  branch  of  the  Government, 
with  the  support  of  Congress  and  the  coopera- 
tion of  State  boards  of  health,  would  have  in  its 
power  to  wipe  out  typhoid  fever,  yellow  fever, 
and  malaria,  and  reduce  enormously  the  mor- 

247 


MEDICAL    SOCIOLOGY 

tality  from  tuberculosis.  It  should  have,  aside 
from  the  intrinsic  merits  of  the  case,  represen- 
tation upon  the  Cabinet  of  the  President.  The 
counsel  of  a  wise  sanitarian  would  be  of  value 
to  every  department  of  the  Government. 

In  the  several  States  the  fields  of  usefulness 
open  to  the  departments  of  health  are  large. 
Gradually  they  are  growing  up  to  their  oppor- 
tunities. As  they  demonstrate  what  can  be 
done,  the  people  give  them  more  money  and  a 
larger  scope.  Some  States  have  efficient  and 
growing  boards  of  health  and  accomplish  much. 
Those  States  which  have  not  yet  awakened  to 
the  value  of  such  work  suffer  for  their  negli- 
gence. 

The  municipal  and  county  departments  of 
health  are  the  most  appreciated.  That  is  be- 
cause they  are  nearest  to  the  people.  All  mu- 
nicipalities are  constantly  increasing  their  effi- 
ciency and  the  field  of  their  work.  The  city  of 
New  York  has  added  to  the  work  of  its  health 
department  the  function  of  having  inspectors  at 
the  farms  where  the  city's  milk  supply  is  pro- 
duced. This  is  a  natural  outcome  of  the  work 
of  inspecting  milk  as  it  comes  into  the  city.  In- 
asmuch as  this  milk  comes  from  six  different 
States,  which  supply  several  hundred  other  mu- 

248 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

nicipalities,  if  each  sent  inspectors  to  the 
sources  of  supply  there  would  be  an  overlap- 
ping of  inspectors,  which  can  only  be  corrected 
by  Federal  supervision.  The  work  of  these 
municipal  health  departments  is  undergoing  a 
steady  evolution.  They  conduct  bureaus  of  vital 
statistics;  inspect  buildings,  factories,  schools, 
etc.;  supervise  case  of  contagious  diseases; 
conduct  hospitals  and  clinical  laboratories 
for  diagnosis;  manufacture  antitoxins  for  the 
poor ;  give  courses  of  instruction  on  health  and 
hygiene;  send  nurses  to  care  for  and  instruct 
the  sick;  provide  food  for  consumptives;  fur- 
nish medical  advice  and  proper  food  for  infants 
in  summer ;  and  in  a  thousand  other  ways  con- 
tribute to  the  health  and  comfort  of  the  people. 
While  the  functions  of  the  other  governmental 
departments  in  our  cities  remain  about  fixed, 
the  power  and  scope  of  the  activities  of  the  de- 
partment of  health  in  every  well-governed  and 
thoughtful  community  is  being  augmented. 

One  of  the  needs  in  our  system  of  medical 
education  is  to  train  men  to  meet  these  new  con- 
ditions. No  college  in  our  country  has  a  course 
in  hygiene  and  sanitation  worthy  of  the  name. 
Doctors  are  to  be  trained  to  fill  the  important 
positions,  arising  on  every  hand,  in  sanitation 

249 


MEDICAL    SOCIOLOGY 

— mimicipal,  State  and  national.  Preventive 
medicine  is  the  thing.  The  need  of  specially 
equipped  men  is  becoming  urgent.  The  first 
school  in  this  country  to  train  men  as  sanita- 
rians will  mark  an  epoch.^ 

These  signs  of  an  advancing  civilization  are 
cited  to  show  the  fields  of  activity  and  useful- 
ness ■  which  are  inevitably  developing  for  the 
medical  man.  He  is  destined  to  be  more  and 
more  of  a  voice  and  a  hand  in  the  multifarious 
functions  of  government. 

'  One  year  after  this  was  written  and  nine  months  after  it  wa3 
first  published,  Columbia  University  announced  that  it  had  twelve 
experts  in  hygiene  and  sanitary  science  at  work  on  a  plan  for  the 
establishment  of  a  school  of  preventive  medicine.  It  is  pro- 
posed to  train  men  for  the  positions  of  health  officers  and  sanitary 
inspectors,  so  that  even  small  towns  may  be  properly  safeguarded 
against  conditions  that  foster  and  breed  disease.  The  proposed 
school  will  seek  to  prevent  tuberculosis,  blindness,  and  alcoholism. 
A  study  of  foodstuffs  and  the  milk  supply  will  be  features  of  the 
course.  This  is  the  most  important  announcement  that  has  ever 
been  made  by  any  medical  school  in  this  country. 


vni 

MEDICAL    SCIENCE    AND    HUMAN    PROGEESS 

AS  the  official  and  public  duties  of  the 
physician  increase  and  diseases  be- 
^  come  less,  there  will  continue  to  be  a 
demand  for  men  who  are  learned  in  human  biol- 
ogy— perhaps  as  great  as  at  this  present  time 
when  we  hear  so  much  of  the  crowded  profes- 
sion. Certainly  there  will  be  less  need  of  the 
therapeutist,  for  if  there  is  any  one  thing  that 
should  be  regarded  as  the  sign  of  advancing 
civilization  it  is  the  recession  of  morbidity. 
There  will  be,  besides  the  general  practitioners 
and  the  specialists,  members  of  the  medical  pro- 
fession occupied  in  the  various  public  medical 
activities.  The  field  of  the  sanitary  engineer  is 
beginning  to  be  developed.  Medical  men  will 
be  required  as  educators.  All  great  undertak- 
ings, involving  human  lives,  will  be  advanced 
under  medical  supervision.  The  blessing  and 
approval  of  the  priest  gives  way  to  the  blessing 
and  approval  of  the  doctor.  We  have  witnessed 
the  transformation.    The  policy  as  exemplified 

251 


MEDICAL    SOCIOLOGY 

by  tlie  armies  of  the  crusaders  must  give  place 
to  the  policy  as  exemplified  by  the  army  of 
Japan  which  multiplied  threefold  the  number 
of  its  medical  men  and  tenfold  their  authority 
and  took  a  stand  away  in  the  van  of  human 
progress.  The  sanitarian  is  to  take  the  place 
of  the  bearer  of  the  sacred  icon.  The  value  of 
medical  supervision  is  demonstrated  at  Pana- 
ma, where  two  continents  are  being  cut  in 
twain;  and  where  men  are  learning  that  the 
operation  to  be  well  done,  or,  indeed,  to  be  done 
at  all,  must  be  performed  with  the  aid  of  the 
physician. 

The  most  fertile  lands  on  the  green  earth 
have  not  yet  been  made  the  abode  of  man.  He 
has  tended  to  grow  away  from  them  and  into 
the  cold  and  uninviting  north,  because  he  could 
eke  out  a  living  where  bacteria  could  not;  and 
where  bacteria  were  everywhere,  he  perished. 
But  medical  science  is  destined  to  banish  the 
infective  diseases  from  the  tropics,  and  open  up 
for  human  habitation  rich  lands  where  the  date 
and  banian  now  grow  unseen  by  human  eyes. 
It  is  destined  to  give  to  mankind  a  new  world, 
equal  in  size  to  that  which  he  now  inhabits,  and 
many  times  more  fertile,  where  grain  will  wave 
and  roses  bloom  the  whole  year  through,  and 

252 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

children  wax  healthy  and  merry  in  lands  now 
pregnant  with  disease. 

It  is  in  making  life  more  livable,  in  shielding 
man  from  the  miseen  enemies  which  prey  upon 
his  body,  in  preserving  his  family,  and  in  com- 
pleting his  mastery  over  the  malignant  powers 
of  nature,  that  the  field  of  medicine  lies.  The 
scientific  study  of  diseases  has  already  lent  its 
aid,  with  importance  equal  to  that  of  astron- 
omy, geology,  or  biology,  in  purging  the  mind 
of  man  of  superstitions  which  since  the  begin- 
ning of  history  have  hampered  his  moral  devel- 
opment. The  current  saying  that  every  doctor 
is  an  atheist  only  means  that  the  mind  of  the 
doctor  is  more  free  from  superstition  than  is 
the  mind  of  the  average  man.  The  ranks  of 
spiritualists  and  religious  fanatics  are  not 
recruited  from  physicians.  The  doctor  has 
learned  to  believe  in  the  eternal  materiality  of 
things  and  in  the  constancy  of  the  forces  which 
connect  them;  and  even  though  causes  may  be 
hidden  from  his  eyes  he  believes  that  they  exist 
and  he  has  faith  that  they  can  be  found.  Pas- 
teur in  discovering  the  relation  to  disease  of 
the  "  infinitely  small "  things  did  as  much  as 
Galileo  in  the  overthrowing  of  superstitions  and 
the  belief  in  miracles. 

253 


MEDICAL    SOCIOLOGY 

We  see  how  far-reaching  are  the  influences 
of  our  science  and  art,  and  how  important  a  role 
they  play  as  human  aids.  They  touch  the  bod- 
ily and  spiritual  welfare  of  the  individual,  of 
the  state  and  of  mankind.  Hand  in  hand  with 
the  progress  of  civilization  go  the  advance- 
ments of  medicine.  Medical  progress  has  ever 
been  an  index  to  human  advancement. 


IX 


PREVENTIVE    MEDICINE 

THE  highest  form  of  service  which  the 
medical  profession  can  perform  for 
mankind  is  in  the  prevention  of  dis- 
eases. This  is  a  field  which  is  entirely  its  own. 
In  the  other  departments  of  medicine  we  come 
within  the  realm  of  the  other  sciences,  such  as 
biology,  chemistry,  and  botany,  but  prophylaxis 
is  distinctly  the  function  of  medicine.  Medicine 
can  never  hope  to  be  of  as  much  value  in  the 
treatment  of  diseases  as  it  can  in  their  preven- 
tion. Cholera,  smallpox,  puerperal  septicaemia, 
yellow  fever — it  is  here  that  humanity  owes  its 
greatest  debt  to  medicine.  But  curiously,  treat- 
ment must  precede  prophylaxis ;  for  it  is  in  the 
long  and  futile  period  of  treatment  that  an  in- 
timacy and  a  familiarity  with  the  disease  is 
bred,  out  of  which  grows  the  knowledge  of  the 
disease  which  makes  possible  successful  proph- 
ylactic measures. 

It  is  in  the  study  of  the  prevention  of  dis- 
18  255 


MEDICAL    SOCIOLOGY 

ease  that  medicine  has  no  rivals,  and  is  the  least 
apt  to  be  misunderstood.  This  realm  is  not  in- 
vaded by  the  charlatan  or  the  pseudo-scientific 
sect.  The  "  schools  "  of  medicine  have  not  to 
do  with  prophylaxis.  They  are  not  interested 
here.  Homeopathy,  osteopathy.  Christian  sci- 
ence, the  Emmanuel  movement,  vitopathy,  and 
the  patent  medicine  movement,  all  are  zealous 
in  the  treatment  of  disease;  but  the  science  of 
medicine  differentiates  itself  from  them  in  that, 
while  they  are  concerned  for  the  sick,  scientific 
medicine  is  searching  out  the  causes  of  disease 
and  applying  preventive  measures.  Medicine, 
as  an  organized  profession,  is  the  only  great 
movement  having  as  an  aim  the  reduction  of 
morbidity  by  preventing  the  well  from  becom- 
ing sick. 

Intelligent  and  scientific  effort  in  the  preven- 
tion of  disease  is  tangible  and  can  be  measured, 
and  is  freer  from  confusion  than  is  treatment. 
In  the  treatment  of  diseases  the  forces  of  na- 
ture are  just  as  kind  to  the  mercenary  quack, 
with  his  "  incomparable  elixir,"  as  they  are  to 
the  conscientious  and  skilled  physician,  who 
hopes  only  for  the  health  of  his  patient.  The 
patients  of  both  will  recover;  and  so,  too,  will 
the  patient  who  is  given  some  noxious  drug. 

256 


MEDICAL   SCIENCE    AN'D    MEDICAL   ART 

The  first  two  will  be  done  no  damage;  the  last 
may  be  either  harmed  or  helped ;  but  misunder- 
standing and  credit  misplaced  have  been  always 
the  accompaniments  of  the  art  of  treatment. 
Therapy  is  the  inexact  part  of  medicine. 

What  has  been  done  toward  the  prevention 
of  cholera  can  be  done  with  typhoid  fever.  The 
fifteen  thousand  persons  who  died  of  this  latter 
disease  in  the  United  States  during  the  past 
year  are  a  needless  sacrifice,  for  medicine  has 
developed  the  knowledge  which,  if  applied, 
would  make  typhoid  fever  an  obsolete  disease. 
Politics  alone  stands  in  the  way.  If  the  medi- 
cal profession  were  given  carte  hlanche  power  to 
eliminate  typhoid,  it  would  be  done.  Medicine 
has  perfected  the  knowledge  of  this  disease  and 
the  means  for  its  prevention,  and  the  people 
want  the  disease  stopped,  but  the  representa- 
tives of  the  people  are  busy  with  mergers  and 
tariffs  and  appropriations  and  jobs,  while  the 
pale  faces  of  those  fifteen  thousand,  dying  of  a 
preventable  disease,  are  seen  only  by  the  pro- 
fession of  medicine.  When  some  community  is 
awakened  by  an  awful  epidemic,  it  arouses  it- 
self, and  some  petty  local  measures  are  applied, 
always  successfully,  to  prevent  the  disease ;  but 
what  is  done  for  a  village  should  be  done  for 

257 


MEDICAL    SOCIOLOGY 

the  State,  for  the  country  and  ultimately  for 
the  world — and  the  disease  would  end. 

This  will  be  done — it  should  be  done  now — 
and  then  typhoid  will  pass  into  history,  a  con- 
quered disease.  In  the  meantime,  your  son,  on 
the  threshold  of  life's  work;  and  your  daughter, 
with  the  roses  of  health  in  her  cheeks;  and 
jour  wife,  the  mother  of  the  laughing  babe ;  and 
you,  who  are  now  reading  these  words,  may  re- 
turn in  the  autumn,  and  lie  down  on  your  bed 
and  die ;  for  the  mergers  must  be  put  through, 
and  the  tariff  must  have  attention,  and  the  ap- 
propriations must  be  passed  round,  and  the 
jobs  are  meat  and  drink. 


THE   DITFUSIOF    OF    MEDICAL,   KNOWLEDGE 

WiEE  we  to  ask  ourselves  the  ques- 
tion, How  can  the  public  appre- 
ciation of  the  art  and  science  of 
medicine  be  improved?  the  answer  would  be, 
education — ^education  of  the  doctor  and  of  the 
public — and  the  means  to  this  end  are  steadily 
at  work.  The  past  generation  has  seen  the 
quality  of  the  doctor  much  improved,  and  none 
of  the  other  branches  of  learning  has  surpassed 
medicine  in  the  march  of  progress.  The  young 
men  now  entering  practice  represent  a  degree  of 
culture  which  gives  to  our  profession  the  flower 
of  manhood;  and  the  preparation  necessary  in 
most  of  our  institutions,  and  the  legal  require- 
ments imposed  in  most  States  for  a  license  to 
practice,  are  all  contributing  to  place  the  medi- 
cal profession  of  the  future  upon  a  higher  plane 
than  ever  before. 

A  unified  profession  is  of  the  next  impor- 
tance.    That  means  laboring  together  in  har- 

259 


MEDICAL   SOCIOLOGY 

mony;  each  giving  freely  to  the  others  what- 
ever of  advantage  he  may  have  to  contribute; 
vying  with  one  another  to  see  who  can  give  the 
most.  Every  commmiity  should  have  its  medi- 
cal society  for  the  interchange  of  ideas  and  the 
reporting  of  experiences.  The  presence  in  a 
community  of  a  medical  library  is  also  of  much 
value.  It  is  surprising  how  one  or  two  high- 
class  men  in  a  locality  doing  advanced  work,  act 
as  an  inspiration  to  the  rest  of  the  profession, 
and  improve  the  habits  and  practices  of  their 
colleagues.  We  find  this  everywhere.  Around 
every  strong  man  there  develops  a  school.  In 
many  small  cities  and  towns  are  groups  of  men 
doing  admirable  work,  sending  abroad  their  in- 
fluence, and  giving  a  higher  tone  to  their  local 
profession. 

General  and  special  societies  help  toward 
the  perfection  of  medical  organization.  A 
great  national  society,  such  as  we  have  in  the 
American  Medical  Association,  can  do  much  for 
the  advancement  of  medicine.  Aside  from  its 
functions  as  a  society,  with  meetings  and  dis- 
cussions, it  can  encourage  the  scientific  spirit 
by  furthering  pure  science  and  offering  encour- 
agement and  rewards  for  scientific  work  and 
discoveries.    Properly,  this  is  the  function  of 

260 


MEDICAL   SCIENCE   AND    MEDICAL   ART 

the  state,  but  the  state  is  not  yet  ready  to  do 
this,  and  only  in  a  few  rare  instances  has  it 
shown  recognition  to  medical  discoveries.  Our 
national  organization  is  steadily  increasing  in 
influence  and  usefulness.  It  has  done  much  in 
the  exposure  of  frauds  in  proprietary  medi- 
cines. It  stands  for  high  ideals.  It  has  ad- 
vanced the  cause  of  medicine  by  endeavoring 
to  secure  a  national  department  of  health;  and 
it  is  conducting  a  scientific  propaganda  against 
sexual  vice  and  other  products  of  public  ignor- 
ance. It  behooves  the  profession  to  take  pride 
in  this  great  association,  and  make  it  as  per- 
fect as  possible  and  a  fitting  representative 
of  its  most  noble  ideals  and  traditions.  Such 
an  organization  can  be  made  to  serve  the  best 
ends  of  the  profession;  it  can  cultivate  pro- 
fessional uniformity  and  unity,  bringing  the 
remote  and  humble  doctor  into  closer  touch 
with  his  most  advanced  and  successful  col- 
league. But,  above  all,  the  most  important 
work  within  the  reach  of  such  a  great  associa- 
tion is  that  which  is  directly  in  line  with  the 
essential  aims  of  our  art — the  advancement  of 
medical  knowledge. 

In  the  relation  of  the  medical  profession  to 
the  people,  a  needful  step  is  the  education  of 

261 


MEDICAL    SOCIOLOGY 

the  public.  By  that,  I  mean,  awakening  in  the 
public  mind  an  appreciation  of  the  function,  the 
aims  and  the  possibilities  of  medicine.  There 
is  an  ancient  and  still  prevalent  notion  that  it  is 
unethical  to  communicate  these  things  to  the 
public,  and  a  certain  medical  aloofness  exists 
which  has  left  the  field  largely  to  that  class  of 
pseudo-scientific  persons  who  take  upon  them- 
selves to  misinform  the  public.  A  barrier  of 
secrecy  has  been  encouraged  by  the  doctors  of 
former  days;  and  relics  of  the  superstitions 
of  medicine  linger  even  yet.  Happily,  the  work 
of  breaking  down  these  obstacles  to  the  ad- 
vancement of  medicine  is  well  under  way.  The 
publications  and  circulars  issued  by  state  and 
municipal  departments  of  health  are  of  much 
value.  Popular  magazine  articles  and  many 
books  give  the  public  further  enlightenment. 
But  still  good  would  accrue  if  medical  men 
would  contribute  more  upon  medical  subjects 
for  popular  reading.  Certain  laymen  have  ren- 
dered good  service  in  this  direction.  The  phy- 
sician need  not  feel  that  in  communicating  med- 
ical knowledge  to  the  public  he  is  laying  himself 
open  to  the  charge  of  self-exploitation  or  of 
invading  the  field  of  the  charlatan.  It  is  the 
charlatan  who  is  ever  invading  his  field.    The 

262 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

campaign  for  the  health  of  the  people  is  a  cam- 
paign of  education.  If  health  departments  are 
to  have  their  work  go  smoothly,  the  people  must 
understand  it  and  be  in  sympathy  with  it.  No 
laws  for  improving  public  health  will  be  satis- 
factory if  the  people  are  ignorant  of  their 
meaning. 

The  need  in  our  general  system  of  public  edu- 
cation to-day  is  the  compulsory  study  and  teach- 
ing of  biology,  human  physiology,  and  hygiene. 
The  most  important  thing  for  the  student  to 
know  about  is  himself,  and  this  study  should 
supersede  all  others.  It  has  taken  two  thou- 
sand years  to  recover  from  the  pernicious 
teaching  that  one  should  give  no  thought  of 
what  he  should  eat,  or  of  what  he  should  drink, 
or  where  he  should  lay  his  head,  or  where  withal 
he  should  be  clothed,  or  even  of  the  morrow; 
but  now  that  enlightened  people  have  rejected 
this  doctrine,  it  may  be  hoped  that  the  race  will 
return  to  the  joy  and  interest  in  its  own  ani- 
mal health,  and  in  the  perfection  of  its  off- 
spring once  displayed  by  those  sturdy  Greeks 
before  they  were  subjugated  by  the  hosts  of 
asceticism  which  deprecated  the  joys  of  this 
world.  The  first  essential  in  the  building  of 
character  and  morality  is  good  health.     The 

263 


MEDICAL   SOCIOLOGY 

morality  that  is  whining  and  sickly  and  prays 
to  be  "  set  free  "  has  done  the  world  irretriev- 
able harm.  The  joy  in  life  and  the  joy  in  the 
great  gifts  of  nature  are  for  the  healthy.  The 
world  needs  the  physically  fit. 

The  engineer  is  most  competent  to  keep  his 
engine  in  a  state  of  efficiency  who  best  knows 
its  construction,  its  workings,  the  dangers  that 
threaten  it,  and  how  to  overcome  them.  The 
most  important  thing  that  concerns  the  student 
is  his  own  body,  and  the  most  important  thing 
that  concerns  the  race  is  its  offspring.  It  is  not 
the  part  of  wisdom  to  study  the  things  all  about 
us  without  knowing  about  the  very  body  for 
whose  benefit  we  presume  to  study  these  things. 
A  student  may  be  able  to  read  in  Greek  of  the 
prowess  of  Alexander,  but  it  boots  him  little  if 
he  is  nearsighted  and  unable  to  ride  a  horse. 
The  overtrained  college  athlete  has  studied  to 
poor  advantage  when  his  heart  gives  out  before 
he  is  fifty.  A  man  may  know  the  history  of  all 
the  tribes  of  Israel,  but  his  life  contains  a  sad 
failure  if  he  is  destined  to  spend  it  with  a  sickly 
wife,  the  relic  of  a  healthy  sweetheart,  whose 
invalidism  and  sterility  are  of  his  own  making 
because  of  his  ignorance. 

Go  into  any  of  the  two  million  homes  in  this 
264 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

land  now  harboring  an  invalid,  and  in  most  of 
them  you  can  trace  without  difficulty  the  dis- 
ease back  to  ignorance.  Most  of  these  sick  are 
suffering  with  preventable  diseases.  In  some, 
the  culpability  lies  with  the  invalid;  in  some, 
with  the  state ;  but  in  all,  the  prophylaxis  lay  in 
education.  Knowledge  and  more  knowledge  of 
ourselves  is  the  need. 

Not  infrequently  we  hear  expressed  the  no- 
tion that  it  is  best  that  laymen  should  not  know 
about  their  bodies.  People  are  going  to  have 
some  sort  of  idea  about  these  things,  and  it 
is  better  that  they  should  know  what  is  true 
than  believe  what  is  false.  In  a  community 
steeped  in  misinformation  the  truth  can  do  no 
harm.  If  they  are  not  taught  the  truth  the 
newspapers  and  the  charlatans  will  see  to  it 
that  they  get  some  sort  of  information.  A  lay- 
man who  thinks  that  a  pain  in  the  back  and  a 
sediment  in  the  urine  are  signs  of  kidney  dis- 
ease is  not  an  educated  man.  Enlighten  the 
public,  and  we  shall  have  enlightened  patients. 
We  need  not  fear  to  teach  the  public  the  prin- 
ciples of  therapeutics.  Nearly  every  layman 
has  some  favorite  remedy  for  something.  Let 
some  one  be  taken  sick  away  from  a  doctor,  and 
witness  the  therapeutic  suggestions  pour  in. 

265 


MEDICAL    SOCIOLOGY 

There  are  certain  fundamental  and  simple 
facts  in  animal  pathology  which  are  of  more 
imjDortance  for  the  individual  to  know  than  that 
he  should  know  of  the  pathology  of  nations,  the 
decay  of  djTiasties,  or  the  moral  pathology  of 
the  French  or  English  court.  Yet  our  children 
are  taught  the  latter  of  these  in  their  schools — 
indeed,  it  is  comjDulsory — but  of  the  former, 
they  know  little. 

If  the  citizen  is  taught  to  take  pride  in  the 
military  conquests  of  his  country  he  should  also 
be  taught  to  take  pride  in  her  conquests  of  dis- 
ease. Let  those  be  honored  who  have  saved 
as  well  as  those  who  have  destroyed.  There  is 
no  war  which  we  should  know  of,  or  be  taught 
with  greater  zeal,  than  the  conquest  of  small- 
pox. The  battle  to  save  our  mothers  from  puer- 
peral sepsis,  waged  by  Semmelweis,  is  of  more 
moment  to  humankind  than  is  any  of  the  bloody 
fields  of  carnage  Creasy  wrote  about.  The  con- 
quest of  pain  by  anesthesia ;  the  victory  of  asep- 
sis ;  the  routing  of  the  bacillus  of  diphtheria  by 
antitoxin;  and  the  factory  over  the  alimentary 
infections  of  infancy,  really  all  concern  us  more 
deeply  than  the  history  of  wars.  History 
should  be  something  more  than  a  narrative  of 
bloodshed  and   commercial   conquests.     There 

266 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

have  been  soldiers  whose  mission  has  been  to 
win  victory  good  for  all  time,  victories,  the  prod- 
ucts of  which  can  never  be  wrenched  from  ns; 
and  the  story  of  these  victories  should  be  known 
to  all. 

This  teaching  should  be  accomplished  by 
school  text-books,  by  formal  history,  and  by 
current  literature.  Medical  associations  could 
do  the  progress  of  medicine  an  additional  serv- 
ice by  supporting  committees  on  publicity  or 
general  enlightenment,  whose  function  it  should 
be  to  advance  the  public  knowledge  and  appre- 
ciation of  the  medical  sciences. 

Some  day  a  Gibbon  or  a  Lecky  or  a  Buckle 
shall  be  raised  up  to  write  an  history  in  which 
the  discoveries  of  medicine  and  the  accomplish- 
ments of  sanitation  shall  be  set  down  in  their 
real  relation  to  the  progress  and  well-being  of 
nations.  The  latter  historian  has  come  very 
near  doing  it  for  England.  Until  that  day  it 
remains  for  us  to  make  the  best  material  for 
the  historian  of  the  future  that  lies  in  our 
power.  Let  us  make  the  records  clear ;  and  the 
historian  shall  find  inspiration  and  joy  in  re- 
cording the  services  of  medicine  to  humanity. 


XI 

COLLEGE  PEEPAKATION  FOR  THE  STUDY  OP  MEDICINE 

THERE  is  much  discussion  concerning 
the  education  that  best  fits  a  man  to  en- 
ter upon  tlie  study  and  practice  of  med- 
icine. There  is  not  only  much  discussion  of  this 
subject  but  much  confusion  as  well.  To  say 
that  a  man  should  have  a  collegiate  education 
before  entering  upon  medical  study  is  confu- 
sing. It  would  be  better  and  more  simple  to 
say  that  he  should  have  an  adequate  education. 
Education  is  a  glorious  institution;  it  is  the 
next  grade  in  human  advancement  below  cul- 
ture. It  should  not  be  confused  with  learning, 
as  it  often  is;  nor  should  it  be  spoken  of  as 
synonymous  with  a  prescribed  period  of  time 
spent  amid  certain  academic  surroundings. 
These  are  all  different  things.  The  education 
which  every  man  should  have,  or  at  least  should 
strive  for,  is  that  which  is  best  calculated  to 
conduce  to  two  things:  his  usefulness  and  his 
happiness.    I  am  much  in  sympathy  with  that 

268 


MEDICAL   SCIENCE   AND   MEDICAL   AET 

man  wlio  said  he  could  not  afford  to  take  the 
time  to  go  to  college  because  he  was  too  busy 
getting  an  education,  even  though  this  obser- 
vation unfortunately  does  imply  something  of 
lack  of  respect  for  that  excellent  organized 
educational  institution,  the  college,  which,  on 
the  whole,  has  more  to  commend  it  than  the 
haphazard  facilities  of  the  extra-collegiate 
world. 

To  demand  that  matriculates  in  medicine 
shall  have  had  a  college  training,  if  not  unwise, 
is  at  least  unfair,  for  the  reason  that  the  college 
training,  with  all  its  preliminary  requirements, 
involves  an  amount  of  time  which  postpones 
too  late  in  life  the  completion  of  the  medical 
study  necessary  for  the  practice  of  medicine. 
To  shorten  the  college  course  by  allowing  the 
last  year  or  two  to  be  applied  to  the  course  in 
medicine,  is  an  admirable  step,  but  it  compels 
the  student  to  study  medicine  in  the  same  in- 
stitution, unless  reciprocity  arrangements  are 
made  between  the  colleges.  Otherwise  such  a 
course  is  not  possible  with  the  college  that  has 
no  medical  department. 

When  the  college  gives  a  training  that  is 
more  practical  and  helpful  and  less  devoted  to 
the  things  of  minor  importance,  when  it  has 

269 


MEDICAL    SOCIOLOGY 

freed  itself  of  the  ancient  traditions  of  culture, 
then  men  may  be  required  to  have  enjoyed  its 
benefits  before  being  allowed  to  take  up  medi- 
cine. The  medical  school  that  requires  the 
bachelor's  degree  for  admission  excludes  many 
of  the  positively  objectionable  men,  but  it  also 
shuts  out  the  one  man,  who  occasionally  comes 
along,  who  would  rise  above  all  the  rest,  and 
who  could  be  of  the  greatest  service  to  medicine 
and  to  humanity. 

Without  entering  into  a  discussion  of  the 
weaknesses  of  the  educational  system  to  which 
our  American  colleges  are  committed,  it  may 
wisely  be  assumed  that  the  medical  student 
should  have  some  sort  of  a  systematic  prelim- 
inary education,  and  the  nearest  approach  to 
what  that  should  be  is  found  in  the  college. 
The  defect  which  could  be  remedied  most  eas- 
ily is  the  defect  of  attempting  too  much.  The 
college  cannot  hope  to  put  the  student  in  pos- 
session of  all  human  Imowledge.  It  should 
help  him  with  that  which  is  most  useful,  train 
his  mind  in  habits  of  observation,  logical  think- 
ing, memory  and  industry,  and  show  him  the  in- 
dex catalogue  of  the  good  things  that  life  has 
to  offer. 

So  far  as  academic  study  and  information  go, 
270 


MEDICAL  SCIENCE   AND   MEDICAL   ART 

the  student  gets  the  most  important  of  these 
before  he  enters  college ;  they  constitute  the  en- 
trance requirements.  The  principles  of  math- 
ematics and  the  rudiments  of  the  languages  and 
sciences  are  the  things  of  importance  to  the 
medical  student,  not  higher  mathematics  and 
the  intricacies  of  tongues  which  he  expects  soon 
to  forget.  Unfortunately  under  this  prevalent 
system  the  very  important  things,  the  princi- 
ples, he  studies  in  the  preparatory  school,  not 
with  an  appreciation  of  their  meaning  and 
value,  but  as  a  grind,  having  for  its  end  the 
unconditioned  admission  to  his  favorite  college. 
He  has  skimmed  through  the  best  of  his  sub- 
jects, and  they  dwell  in  the  past  as  a  vague 
dream.  The  best  results  will  be  secured  when 
the  student  has  more  rudimentary  teaching  in 
college.  Let  the  requirements  for  admission  be 
less  rigid,  so  that  a  man  may  enter  at  fifteen 
and  devote  the  first  years  of  his  college  life 
thoughtfully  and  deliberately  to  those  impor- 
tant things  which  the  preparatory  school  now 
attempts  to  teach  him,  but  which  the  college, 
beckoning  him  on,  compels  him  to  touch  but 
superficially. 

Our  one  mistake  is  to  combine  the  college  and 
university.    These  two  should  be  separate.  The 
19  271 


MEDICAL    SOCIOLOGY 

boy  at  college  gives  much  attention  to  athletics, 
the  fraternity  and  his  chums.  This  is  well  and 
good;  but  this  so-called  college  life  cannot  be 
advantageously  combined  with  the  work  of  the 
student  who  is  really  a  university  man  and  en- 
gaged in  the  scientific  study  of  subjects  for  his 
life  work.  It  is  also  true  that  the  boy's  college 
studies  are  not  made  sufficiently  vital  to  him, 
as  something  to  help  him  in  life.  They  do  these 
things  better  in  Germany.  There  the  univer- 
sity is  a  university  de  facto,  where  the  student 
studies  his  special  subject,  and  may  follow  it 
to  the  full  extent  of  human  knowledge.  The 
gymnasium  prejDares  him  for  the  university; 
but  the  gjTnnasium  is  also  an  institution  of 
learning,  and  has  not  for  its  aim  and  end  the 
quiz  compend  function  of  the  American  pre- 
paratory school.  We  have  a  few  preparatory 
schools  which  are  worthy  of  a  better  name,  and 
they  might  wisely  be  remodeled,  slightly  ampli- 
fied, and  send  their  graduates  directly  to  their 
special  university  studies.  Our  so-called  col- 
leges and  universities  are  something  less  than 
universities  and  more  than  colleges.  They  are 
becoming  unwieldy  and  complex.  In  the  de- 
partment of  arts  the  contact  of  pupil  with 
teacher,  so  valuable  in  the  old-time  college,  has 

272 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

disappeared.  The  best  thing  they  have  to  offer 
is  the  contact  of  student  with  student  under  cer- 
tain regulations  and  in  an  atmosphere  of  cul- 
ture. Aside  from  this  the  student  may  profit 
by  his  opportunities  little  or  much  as  he  pleases, 
just  as  he  might  if  he  were  in  any  other  posi- 
tion in  life. 

I  cannot  conclude  without  offering  the  sug- 
gestion that  the  college  will  attain  to  its  great- 
est usefulness  only  when  it  becomes  a  less  pecu- 
liar institution.  By  that  I  mean,  it  should 
approach  more  closely  the  conditions  of  the  life 
for  which  it  is  preparing  its  students.  The  mo- 
nastic life,  as  an  educational  scheme,  is  a  fail- 
ure. The  period  of  a  man's  usefulness  is  short, 
and  life  is  too  precious  for  one  to  step  aside 
from  the  path  of  usefulness  and  isolate  himself, 
professedly  for  self -improvement,  for  a  period 
of  years,  and  then  hope  to  come  back  and  im- 
mediately take  up  work  as  a  useful  member 
of  the  community.  The  best  way  to  prepare 
for  the  life  that  one  aims  to  lead  is  to  live  it. 
The  best  schooling  for  usefulness  is  to  be  use- 
ful. When  our  college  system  is  perfected  the 
student  will  spend  a  certain  part  of  each  day 
in  some  useful  occupation — some  occupation 
which  in  the  terms  of  the  world  has  a  com- 

273 


MEDICAL    SOCIOLOGY 

mercial  value.  The  best  way  to  learn  chem- 
istry is  to  teach  it  at  the  same  time;  and  so 
the  enlightened  student  will  teach  those  who 
are  less  enlightened  than  he.  When  a  student 
begins  to  have  a  grasp  of  a  subject  then  he 
should  face  about  and  take  some  part  in  teach- 
ing those  who  are  less  proficient.  Upper  class 
men  should  be  instructors  of  lower  class  men. 
Then  there  should  be  practical  work  with  the 
hands.  Hoeing  potatoes  is  just  as  good  exer- 
cise as  golf,  and  sawing  wood  is  a  splendid 
preparation  for  the  oarsman,  if  one  does  these 
things  in  the  right  spirit.  The  negroes  at 
Tuskegee  have  discovered  this.  Harvard  must 
learn  it. 

In  medical  schools  the  monastic  policy  has 
recently  been  disposed  of.  The  medical  student 
no  longer  gains  his  knowledge  by  sitting  at  the 
feet  of  the  grave  and  learned  teachers,  drinking 
in  their  words  of  wisdom  and  deluding  himself 
that  he  is  securing  a  medical  education.  No; 
he  walks  the  wards,  he  examines  cases,  he  pre- 
scribes, he  puts  on  dressings,  he  takes  histories, 
he  makes  analyses.  In  fine,  he  prepares  for 
practicing  medicine  by  practicing  it  and  seeing 
it  practiced;  and  this  has  been  found  to  be  the 
key  to  medical  teaching.    If  he  has  good  teach- 

274 


MEDICAL   SCIENCE   AND    MEDICAL   ART 

ers  lie  observes  that  they,  too,  are  students. 
The  boy  is  father  to  the  man.  He  recog- 
nizes no  line  of  demarcation;  and,  if  he  has 
been  well  taught,  a  student  he  remains  al- 
ways. 


xn 

THE   HOSPITAL   INTERNESHIP 

SOME  day  no  student  will  be  graduated  in 
medicine  and  licensed  to  practice  unless 
he  has  had  hospital  experience.  The 
hospital  will  supplant,  to  a  large  degree,  the 
lecture  hall.  Students  will  be  taught  more  at 
the  bedside.  Some  day  the  hospital  and  the 
patients  will  appreciate  the  advantage  of  hav- 
ing students  in  the  wards.  But  that  day  is  not 
yet.  At  present  a  minority  of  graduates  in 
medicine  have  hospital  experience.  This  is  se- 
cured by  taking  the  competitive  examination 
for  positions  on  the  resident  or  interne  staff 
of  the  hospitals. 

The  student  about  to  graduate  in  medicine, 
casts  his  covetous  eye  about  for  the  hospital 
whose  congenial  walls  shall  receive  him  and 
harbor  him  for  some  two  years,  while  he  pur- 
sues the  work  which  he  hopes  will  culminate  in 
the  making  of  a  doctor.  He  is  fortunate,  in- 
deed, if  he  rids  himself  of  the  idea  that  he  is 

276 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

after  a  hospital ;  lie  is  wise  if  he  is  imbued  with 
the  thought  that  he  is  seeking  knowledge  and 
experience.  There  will  be  classmates  of  his 
who,  without  becoming  internes,  will  excel  him 
in  both  of  these.  The  interneship  is  but  an  op- 
portunity; there  are  many  others.  The  ear- 
nestness and  the  fidelity  and  the  thoroughness 
that  he  puts  in  his  study  tell  the  story.  He  can 
get  out  of  his  cases  only  the  knowledge  that  he 
works  out  of  them.  There  is  no  easy-chair 
method.  Scientific  knowledge  must  be  worked 
for ;  it  is  never  a  gratuity.  So  let  the  student  try 
for  his  interneship;  he  is  fortunate  if  he  gets 
it — fortunate  for  the  opportunities  which  it  af- 
fords. Happy  is  he  if  his  college  has  taught 
him  enough  of  a  subject  to  whet  his  appetite 
for  more. 

Let  us  understand  that  we  are  brothers,  and 
always  students,  in  a  great  confraternity.  It  is 
for  none  to  arrogate  to  himself  the  title  of  mas- 
ter. The  interne  of  yesterday  is  the  attending 
of  to-day;  and  the  knowledge  of  each  is  incom- 
plete. Happy  the  two  if  they  work  together  as 
fellow-students  in  mutual  helpfulness  and  sym- 
pathy. That  hospital  is  a  blessing  in  which  the 
attending  has  a  personal  delight  in  the  faith- 
fulness of  the  house  surgeon  and  the  thorough- 

277 


MEDICAL    SOCIOLOGY 

ness  and  perspicuity  of  the  historian,  and  in 
which  the  internes  observe  with  pride  the  diag- 
nostic acumen  and  therapeutic  skill  of  the  at- 
tending, which  he  has  developed  out  of  the  same 
opportunities  which  now  are  theirs. 

I  have  heard  a  house  physician  boast  that  he 
had  had  entire  charge  of  the  service  ever  since 
he  came  on  duty.  He  might  have  had  that  any- 
where in  the  great  outside  world  of  private 
practice.  Here  is  a  house  surgeon  who  tells 
that  he  did  six  abdominal  sections  in  a  week, 
but  the  chances  are  that  the  attending  surgeon 
was  either  lazy  with  satiety  or  indifferent  with 
overwork. 

The  hospital  interne  is  better  off  in  the  hos- 
pital where  he  is  associated  with  thorough, 
painstaking,  and  conscientious  attendings,  who 
treat  him  as  a  fellow-student,  working  together 
with  them  to  learn  and  to  improve  themselves 
in  their  branch  of  medical  knowledge,  than  he 
is  in  an  institution  where  he  is  given  responsi- 
bilities, and  goes  it  alone  without  the  coopera- 
tion of  those  of  greater  experience,  knowledge, 
and  skill.  All  his  life  must  be  one  of  personal 
responsibility;  in  the  hospital  he  should  bend 
his  energies  to  learning  from  others  and  with 
others. 

278 


MEDICAL   SCIENCE    AND   MEDICAL   AKT 

And  here  I  come  to  the  question  of  learning. 
Learning  is  of  value  as  it  has  trained  the  mind 
and  the  hand,  and  as  it  is  available  when  need- 
ed. I  once  saw  a  case  of  trichinosis  slip  through 
the  diagnostic  fingers  of  three  men,  and  be 
caught  by  the  fourth  who  had  never  before  seen 
a  case;  and  the  first  three  could  have  passed  a 
better  examination  in  trichinosis  than  the  man 
who  caught  the  pig.  The  first  three  had  been 
hospital  internes,  the  last  had  not.  Number 
four  had  no  more  knowledge  of  the  subject  than 
the  others,  but  he  had  his  knowledge  formulated 
and  available.  He  had  it  in  prospective  rela- 
tion to  a  case  of  trichinosis;  the  others  had 
theirs  wrapped  up  and  pigeonholed  as  inde- 
pendent abstract  material.  It  is  the  business  of 
the  student  to  run  a  wire  to  his  knowledge,  and 
keep  the  line  in  order. 

Finally,  it  is  not  the  college,  it  is  not  the  hos- 
pital, it  is  the  animus  within  the  man  that  shall 
make  him  superior.  If  he  has  the  thirst  for 
knowledge,  he  shall  have  it ;  if  he  has  the  long- 
ing to  perfect  himself,  he  shall  excel.  We  have 
pretty  much  what  we  desire;  provided  always 
that  we  are  worthy  and  capable.  There  is  many 
a  country  practitioner — who  once  had  the  ad- 
vantages of  the  help  and  sympathy  of  a  good 

279 


MEDICAL    SOCIOLOGY 

preceptor,  but  never  the  advantages  of  a  hos- 
pital interneship — who  carefully  studies  his 
cases,  thinks  about  them,  reads  about  them, 
compares  them  with  previous  cases,  who  is 
above  ready-made  diagnoses  and  ready-made 
prescriptions — ^who  is  in  his  art  and  science  a 
peer,  and  in  his  community  the  well-beloved 
physician  and  the  noblest  type  of  a  well-rounded 
man. 


XIII 

STATE   AND   COLLEGE   MEDICAL  EXAMINATIONS 

THE  large  amount  of  discussion  and  the 
diversity  of  opinions  prevalent  upon 
tlie  subject  of  medical  education  and 
medical  examinations  show  a  restlessness  and 
a  certain  degree  of  dissatisfaction  which  are 
salutary.  An  association  of  American  Medical 
Colleges  has  been  organized,  and  its  work  has 
resulted  in  an  elevation  in  the  standards  of  re- 
quirements for  the  doctor's  degree.  While  the 
teaching  of  medicine  has  made  advances  along 
practical  lines,  the  examination  of  the  student, 
to  test  the  learning  that  he  has  derived  from  his 
teaching,  has  not  progressed  so  far.  The  old 
methods  of  oral  and  written  examinations, 
chiefly  the  latter,  are  still  the  main  reliance  of 
the  examiner.  We  know  how  imperfectly  these 
examinations  test  the  merits  of  the  student,  and 
we  know  how  important  a  part  is  played  by  the 
cramming  process  and  the  expedients  which 
constitute  short  cuts  to  success  in  examinations. 

281 


MEDICAL    SOCIOLOGY 

The  function  of  the  doctor  is  a  complex  one. 
He  has  many  things  to  do,  all  of  a  practical 
nature,  and  he  must  know  many  things.  A  doc- 
tor must  have  knowledge  which  cannot  be  con- 
densed in  a  compend  or  even  in  a  more  preten- 
tious volume,  and  which  the  answering  of 
questions  does  not  test.  A  student  may  be  able 
to  answer  as  well  as  his  professor  the  question, 
What  are  the  symptoms  of  scarlatina?  but,  does 
he  know  scarlatina  when  he  sees  it? — that  is  the 
question.  How  would  you  treat  a  fracture  of 
the  lower  end  of  the  radius  1  may  be  glibly  and 
correctly  answered  by  one  who  is  not  able  to 
treat  correctly  a  fracture  of  the  lower  end  of 
the  radius.  A  practical  examination  is  needed. 
In  many  of  our  medical  schools  such  an  exam- 
ination is  conducted  in  part:  the  students  are 
marked  in  their  practical  and  clinical  work,  and 
these  marks  figure  in  the  ultimate  result.  Many 
hospital  examinations  for  internes  combine  the 
practical  and  theoretical.  These  examinations 
often  demonstrate  that  a  man  who  passes  an 
acceptable  written  examination  is  not  qualified 
for  the  honorable  title  of  doctor.  If  the  state 
recognizes  him  as  such,  his  title  should  be  Doc- 
tus  sed  non  Doctor.  The  state  examinations  are 
written  and  not  practical,  still,  it  would  not  be 

282 


MEDICAL   SCIENCE   AND  MEDICAL   AET 

difficult  to  make  them  practical.  If  the  hospi- 
tals can  do  it  the  state  can  do  it.  It  is  success- 
fully done  in  Germany,  where  the  candidate  is 
not  granted  a  license  to  practice  until  he  has 
shown  actually  that  he  has  practical  qualifica- 
tions. He  must  display  his  ability  to  diagnose 
diseases,  to  make  examinations,  and  to  conduct 
treatment. 

The  horrible  imputation  used  to  be  made  that 
in  certain  states  a  man  without  medical  train- 
ing, with  a  good  memory  and  a  quiz  compend, 
could  pass  the  state's  examination;  and  if  he 
had  the  quiz  compend  in  his  pocket  he  need  not 
even  have  a  good  memory.  We  should  doubt 
the  correctness  of  these  assertions;  but  the 
mere  fact  that  such  statements  have  been  made 
reflects  upon  the  practical  character  of  the  ex- 
aminations. 

One  of  the  blighting  influences  upon  the  study 
and  teaching  of  medicine  is  the  examination 
system.  Its  pernicious  effects  may  be  seen 
from  the  beginning  to  the  end  of  the  modem 
medical  curriculum.  Unfortunately,  the  exam- 
ination fetich  is  gaining  a  stronger  hold  upon 
medical  education  instead  of  declining.  Its  in- 
fluence is  detrimental  to  our  true  aims.  The 
present  methods   of  conductiag  examinations 

283 


MEDICAL   SOCIOLOGY 

have  a  demoralizing  effect  upon  both  the  student 
and  teacher.  According  to  Matthew  Arnold,  the 
true  aim  of  education  is  "  to  develop  the  power 
of  our  minds  and  to  give  us  access  to  vital 
knowledge."  If  the  modern  examination  sys- 
tem does  discover  the  powers  of  mind  or  the 
possession  of  vital  knowledge,  then  it  is  good. 
But  does  it!  Is  it  possible  for  an  examiner  who 
has  never  seen  the  candidate  before,  by  asking 
a  few  questions,  to  discover  "  the  powers  of  his 
mind,"  and  determine  whether  he  is  educated 
or  no  ?  By  this  "  external  examination,"  the 
powers  of  the  mind  can  be  tested  only  to  a  very 
limited  degree.  One  power  of  the  mind  is 
tested,  and  that  is  the  power  of  passing  exam- 
inations— the  power  of  quickly  recalling  things 
recently  learned.  Lauriston  E.  Shaw  says  that 
it  is  just  as  illogical  continually  to  worry  a  man, 
who  is  trying  to  develop  the  higher  faculties  of 
his  mind,  with  investigations  as  to  his  memory, 
as  it  would  be  periodically  to  test  the  lifting 
power  of  a  man  who  is  learning  to  play  the 
fiddle.  The  student  is  studying  medicine  to  per- 
fect himself  in  the  observation  and  treatment  of 
disease,  not  to  cultivate  his  memory  and  his 
self-confidence. 
"  We  tell  whether  a  man  has  been  well  edu- 
284 


MEDICAL   SCIE^TCE    AND   MEDICAL   ART 

cated  not  by  what  lie  knows  but  by  what  he  can 
understand."  It  is  not  the  answer  to  questions 
that  examiners  should  want,  but  rather  knowl- 
edge of  the  fitness  of  the  candidate  to  practice 
medicine. 


XIV 

THE    STATE   LICENSE    TO    PEACTICE    MEDICINE 

THE  present  medical  laws  in  most  of  the 
States  are  the  best  that  could  be  secured 
at  the  time  of  their  enactment.  They 
have  served  an  excellent  purpose  in  protecting 
the  people  from  the  worst  types  of  incompe- 
tence. Their  value  has  been  appreciated;  and 
many  have  been  in  operation  long  enough  for 
their  weaknesses  to  have  been  made  manifest. 
A  weakness  in  some  is  that  they  keep  alive  the 
so-called  "  schools  of  medicine,"  which  are  not 
entitled  to  be  regarded  as  separate  schools  and 
which  in  reality  do  not  exist.  Homeopathic  and 
eclectic  medicine  have  practically  disappeared; 
still,  the  laws  of  some  states  keep  alive  the  de- 
lusion that  they  do  exist. 

There  is  decided  harm  in  laws  which  create 
two  or  three  separate  examining  boards.  Other 
"  schools "  of  peculiar  therapeutics  are  de- 
manding the  same  special  privileges  which  al- 
ready have  been  accorded  to  the  two  "  schools  " 

286 


MEDICAL   SCIENCE    AND   MEDICAL   ART 

now  recognized.  The  same  laws,  it  is  insisted, 
which  apply  to  homeopathy,  should  apply  to  os- 
teopathy, provided  each  complies  with  the  same 
requirements;  and  legislators  cannot  much 
longer  be  made  to  see  it  in  any  other  light. 
When  the  state  recognized  one  peculiar  sect  it 
opened  the  way  to  recognize  all. 

Before  this  absurdity  has  gone  any  further  it 
should  be  stopped.  There  should  be  a  single 
examining  board  in  each  State,  whose  business 
it  should  be  to  examine  into  the  qualifications 
of  candidates  applying  for  a  license  to  practice 
the  healing  art.  Some  States  have  adopted  this 
system.  This  board  should  determine  partic- 
ularly the  candidate's  knowledge  of  the  hu- 
man body  and  its  diseases,  their  causes,  their 
effects  upon  the  body,  their  prevention  and 
their  treatment.  Of  treatment,  the  most  that 
we  can  demand  is  that  it  shall  be  either  rea- 
sonable or  authoritatively  sanctioned;  and  ad- 
vances of  medical  science  will  constantly  make 
this  a  variable  subject.  What  was  authorita- 
tively sanctioned  treatment  twenty  years  ago 
would  not  satisfy  the  demands  of  a  present-day 
examining  board;  and  we  may  draw  the  same 
odious  comparison  between  some  of  our  modem 
therapeutics  and  that  of  twenty  years  hence. 
20  287 


MEDICAL    SOCIOLOGY 

This  board  should  determine  that  a  candidate 
has  complied  with  certain  educational  require- 
ments, at  least  as  high  as  are  now  insisted 
upon;  and,  having  a  satisfactory  knowledge  of 
the  science  of  medicine,  he  should  be  licensed 
and  allowed  much  latitude  in  his  choice  of  treat- 
ment, A  doctor  whom  the  state  recognizes 
should  be  simply  a  doctor.  The  state  should 
know  no  homeopaths,  eclectics,  osteopaths,  or 
hydropaths.  Therapeutics  is  but  a  small  part 
of  the  science  of  medicine.  It  should  be  the 
privilege  of  the  licensed  doctor  to  use  small 
doses  or  large  doses,  massage  or  hydrotherapy, 
or  whatever  he  please,  provided  he  be  well 
grounded  in  the  fundamentals  of  medical  sci- 
ence. 

While  the  United  States  generally  have  sup- 
ported high  educational  standards  in  the  in- 
terest of  the  health  of  the  people,  it  should  not 
be  lost  sight  of  that  there  have  been  continuous 
assaults  aimed  against  these  high  standards. 
The  enactment  and  maintenance  of  salutary 
medical  laws  have  not  been  altogether  without 
opposition. 

To  the  medical  profession  belongs  the  credit 
of  having  created  these  standards.  It  has  been 
the  medical  profession  that  has  served  the  high- 

288 


MEDICAL    SCIENCE    AND   MEDICAL   AET 

est  interests  of  the  people  by  imposing  higher 
and  more  difficult  requirements  upon  itself. 
Behind  every  act  of  legislation  which  has  raised 
the  standard  of  requirements  for  the  practice 
of  medicine  has  stood  the  great  body  of  its  medi- 
cal men.  They  have  supported  every  act  of 
legislation  which  has  aimed  to  preserve  the 
health  of  the  people,  to  improve  sanitary  condi- 
tions and  to  minimize  sickness. 


XV 

THE    PRACTICE    OF    MEDICINE    LEGALLY    DEFINED 

AN  adequate  definition  of  what  consti- 
tutes the  practice  of  medicine  has  long 
.  been  a  desideratum  whereby  to  deter- 
mine compliance  with  the  medical  practice  law 
or  violation  of  the  same.  The  Appellate  Divi- 
sion of  the  Supreme  Court  of  New  York  State 
rendered  a  decision  in  1907  which  supplies  this 
want.  The  judgment  of  the  Appellate  Court  is, 
that,  to  confine  the  definition  of  the  words 
"  practice  of  medicine  "  to  the  mere  adminis- 
tration of  drugs  or  the  use  of  surgical  instru- 
ments would  be  to  eliminate  the  very  comer- 
stone  of  successful  medical  practice — namely, 
diagnosis.  The  court  holds  that  such  an  inter- 
pretation would  rule  out  of  the  profession  the 
eminent  men  whose  work  is  confined  to  consul- 
tation and  diagnosis.  Diagnosis  is  an  integral 
part  of  both  the  study  and  the  practice  of  medi- 
cine. The  court,  citing  the  instance  of  consump- 
tion, which  may,  if  discovered  in  time,  be  ar- 

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MEDICAL   SCIENCE   AND   MEDICAL   ART 

rested  and  eradicated  by  simple  hygienic  treat- 
ment, and  that  in  the  treatment  of  this  disease 
drugs  have  been  practically  given  up,  pro- 
pounded the  question,  "  Would  the  physician, 
in  such  a  case,  who  by  his  skill  discovered  the 
incipient  disease,  advised  the  open-air  treat- 
ment and  refrained  from  administering  drugs, 
not  be  practicing  medicine"?"  The  court  re- 
ferred to  the  statement  of  another  court  in  a 
similar  case  to  the  effect  that,  "  the  day  has 
passed  when  it  was  thought  that  a  physician's 
advice  was  of  no  use  unless  he  ordered  a  dose 
of  medicine." 

It  is  held  that  the  purpose  of  the  medical  law 
is  to  protect  the  people  against  charlatanism, 
ignorance,  and  quackery,  and  that  it  is  not  the 
legislative  intent  to  restrict  the  examination  of 
those  desiring  to  practice  medicine  solely  to 
that  class  of  the  profession  who  may  prescribe 
drugs.  This  decision  was  arrived  at  after  a 
study  of  the  authorities  throughout  the  country, 
and  from  examination  into  the  history  and 
growth  of  our  own  public  health  laws. 


XVI 

THE   MEDICAL   EXPERT   WITNESS 

THE  medical  expert  witness  often  is 
spoken  of  in  derision.  Unfortunately 
the  derisive  comments  are  not  confined 
to  the  lay  press,  but  the  medical  press  also  has 
not  hesitated  to  cast  its  calumny  upon  him.  Is 
this  opprobrium  justified  by  the  facts? 

Medical  men  are  subject  to  the  same  defects 
of  judgment  and  limitations  of  insight  as  be- 
long to  other  men.  They  are  not  peculiar  in 
freedom  from  human  weaknesses.  Medical  men 
can  be  differentiated  from  other  men  in  two  re- 
spects :  they  represent  as  a  whole  as  high  moral 
qualities  as  any  class,  and  they  possess  the 
greatest  knowledge  of  the  human  body  and  its 
diseases.  These  two  assertions  are  easy  to  de- 
fend. 

If  expert  medical  testimony  is  required,  the 
best  man  from  whom  to  get  it  is  a  doctor  of 
medicine.  Occasions  always  will  arise  when 
such  testimony  will  be  desired.     It  is  sought 

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MEDICAL    SCIENCE   AND   MEDICAL   ART 

from  him,  according  to  Mr.  Chief  Justice  Shaw, 
"  because  his  professional  pursuits,  his  peculiar 
skill  and  knowledge  in  some  department  of  sci- 
ence, not  common  to  men  in  general,  enables 
him  to  draw  an  inference,  where  men  of  com- 
mon experience,  after  all  the  facts  proved, 
would  be  left  in  doubt." 

Why  do  the  apparent  discrepancies  of  testi- 
mony occur  which  foster  the  misconceptions 
concerning  the  medical  expert  witness  with 
which  we  are  so  familiar  1  The  answer  is  to  be 
found  in  the  codes  of  proceedings  of  the  courts, 
in  certain  laws  of  the  state  which  make  for  in- 
justice, in  the  license  which  the  courts  place  in 
the  hands  of  the  examining  counsel,  and  the 
limitations  to  which  the  witness  is  confined,  and 
not  in  the  honesty  or  knowledge  of  the  expert. 

Of  all  the  devices  created  by  the  law,  which 
make  for  the  subversion  of  justice,  the  hypo- 
thetical question  stands  among  the  preeminent. 
Give  a  skillful  lawyer  the  privilege  of  asking 
questions,  real  or  hypothetical,  to  be  answered 
by  "  yes  "  or  "  no,"  and  he  can  frame  them  in 
such  a  way  as  to  put  the  answer  in  the  witness' 
mouth;  the  lawyer  who  cannot  ask  an  hypothet- 
ical question  in  such  a  way  as  to  get  the  answer 
he  desires  is  not  a  clever  lawyer.    It  is  framed 

293 


MEDICAL    SOCIOLOGY 

so  as  to  secure  in  one  word  the  answer  to  a  num- 
ber of  questions ;  and  few  medical  experts  ever 
answered  such  a  question  without  a  feeling  of 
resentment  at  its  unfairness,  or  at  least  a  de- 
sire to  qualify  the  answer  by  further  explana- 
tions. The  witness  is  required  to  give  his 
opinion  upon  a  great  collection  of  supposed 
facts,  but  we  do  not  know  what  his  opinion 
would  be  if  one  of  these  supposed  facts  were 
withdrawn  or  were  discovered  not  to  be  a  fact. 
He  is  asked  for  the  truth,  and  nothing  but  the 
truth,  and  then  is  not  permitted  to  tell  it. 

Another  unfortunate  side  to  this  question  is 
that  the  expert  witness  is  made  to  have  a  finan- 
cial interest  in  one  side  of  the  case.  A  certain 
opinion  is  sought  and  it  is  to  be  paid  for.  No 
fair  or  generous  man  lives  who  has  something 
to  give,  the  giving  of  which  costs  him  nothing, 
and  who  is  to  be  well  paid  for  it,  but  will  tend 
unconsciously  to  give  freely  what  is  wanted. 
It  is  for  this  reason  that  the  expert,  no  matter 
how  honest  he  is,  leans  toward  the  side  that 
employs  him.  This  prejudice  will  exist  until  he 
is  made  to  stand  upon  neutral  ground.  Neutral 
ground  can  only  be  secured  by  requiring  the 
witness  to  testify  as  to  the  nature  of  the  case, 
being  retained  by  both  or  by  neither  side.    The 

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MEDICAL    SCIENCE   AND   MEDICAL   ART 

court  should  desire  the  impartial  truth,  and  in 
order  to  secure  it  the  expert  witness  must  l)e 
in  a  position  to  be  as  impartial  as  the  judge. 

It  is,  moreover,  clearly  unfair  to  ask  from  a 
medical  man  judgment  upon  a  case  without  his 
having  had  an  opportunity  to  examine  the  pa- 
tient. Particularly  is  this  so  if  another  medical 
man,  who  is  to  testify  "  on  the  other  side,"  has 
had  such  an  opportunity.  It  is  earnestly  to  be 
wished  that  lawyers  might  realize  that  in  medi- 
cine there  is  no  "  other  side."  The  truth  is  all 
there  is. 

If  medical  witnesses  are  summoned  by  the  two 
sides,  let  them  have  a  fair  and  equal  opportu- 
nity to  examine  the  patient  together,  and  dis- 
cuss the  case  as  they  would  in  a  consultation, 
and  it  will  be  found  pretty  generally  that  they 
agree.  Men  who  are  really  experts  are  all  pos- 
sessed of  the  best  knowledge  of  their  subject. 
Medicine  as  a  science  is  not  so  very  inexact.  Let 
these  men  be  called  upon  the  witness  stand.  Let 
them  not  be  handed  over  as  automatons  to  the 
contending  counsels  to  be  bandied  about;  but, 
as  men  of  intelligence  and  knowledge  from 
whom  the  court  desires  the  truth,  let  them  be 
allowed  to  elucidate  the  question,  and  it  will  be 
found  generally  that  they  are  of  the  same  opin- 

295 


MEDICAL    SOCIOLOGY 

ion  in  the  court  room  as  they  are  in  the  examin- 
ing room. 

It  is  the  trick  of  the  lawyer  to  make  the  medi- 
cal expert  his  tool.  It  is  to  the  discredit  of  the 
courts  that  this  is  so.  The  lawyer's  practice 
is  to  present  one  side  of  a  case,  the  doctor's 
practice  should  be  to  deal  squarely  with  the 
whole,  and  to  subvert  this  practice  means  mis- 
understandings. 

The  hue  and  cry  against  the  medical  expert 
is  virtually  a  reflection  not  upon  him,  but  upon 
the  practice  of  our  courts  and  the  laws  which 
govern  them,  and  which  are  responsible  for  the 
injustice  which  makes  him  one  of  its  victims. 


XVII 

THE   PRECEPTOR 

1WISH  that  we  might  have  restored  to  us 
in  some  way  the  old  relation  of  preceptor 
and  pupil.  Personality  is  such  a  strong- 
factor  in  teaching,  it  is  a  great  loss  to  sacrifice 
it.  Teaching  is  becoming  a  composite  and  com- 
plicated function — like  much  of  our  modem-day 
processes,  it  is  gaining  in  efficient  machinery 
but  losing  in  inspiring  personality.  I  would  not 
say  that  students  are  not  taught  better  now 
than  ever  before,  nor  would  I  say  that  shoes 
are  not  made  better  now  than  in  the  olden  days ; 
but  the  passing  of  the  dear  old  cobbler,  who  was 
my  neighbor,  and  who  hoed  in  his  garden  after 
supper,  has  deprived  me  of  just  that  much  hu- 
man kinship.  The  medical  student  needs  to 
hear  the  living  voice  of  the  master. 

It  is  of  great  value  to  a  young  man  to  have  a 
whole  man  as  his  ideal.  Let  me  explain:  The 
student  now  divides  his  time  equally  among 
many  teachers.    He  admires  this  one's  diagnos- 

297 


MEDICAL    SOCIOLOGY 

tic  acumen,  that  one's  painstaking  honesty,  and 
the  splendid  therapeutic  technic  of  another ;  but 
when  all  are  done  and  he  goes  to  work  for  him- 
self his  ideal,  if  he  has  any,  is  a  composite,  not 
a  loved  and  respected  individual;  and  a  com- 
posite lacks  bowels. 

The  broad  field  of  medicine  will  never  again 
be  mastered  by  any  single  man.  Students  have 
long  ago  ceased  to  go  to  Leyden  to  study  with 
Gaubius.  The  student  now  in  his  college  work 
comes  under  the  influence  of  a  number  of  teach- 
ers, each  excelling  in  his  special  branch.  But 
it  is  possible  for  him  when  he  enters  into  prac- 
tice to  enjoy  the  advantage  of  which  the  modem 
stress  of  the  times  has  deprived  him.  Then  if 
he  can,  as  an  assistant  or  an  associate,  become 
attached  to  some  practitioner,  whom  time  and 
experience  have  made  both  wise  and  venerable, 
he  is,  indeed,  a  fortunate  youth.  This  is  one  of 
the  reasons  why  the  doctor's  son  enjoys  an  es- 
pecial advantage;  he  has  a  preceptor  whom  he 
respects  and  who  loves  him.  We  can  best  have 
ideals  by  seeing  them  in  reality. 


xvni 

THE   GENEKAL  PRACTITIONER   AND   THE   CLINICAL 
ASSISTANT 

THE  time  was  when  the  practitioner 
of  medicine  worked  independently  and 
alone,  jealous  of  his  own  knowledge  and 
skill.  The  modern  practitioner  does  not  harbor 
this  jealousy,  but  lives  and  works  in  an  atmos- 
phere of  cooperation.  The  principles  of  reci- 
procity are  to  be  still  further  amplified  among 
practitioners  of  medicine.  No  better  fortune 
can  come  to  the  young  man,  even  though  he  has 
just  finished  an  interneship,  than  to  begin  his 
practice  in  close  association  with  a  well-edu- 
cated physician  with  a  good-sized  clientele. 
The  younger  man  should  be  his  senior's  assis- 
tant. His  value  will  be  in  the  finer  methods  of 
clinical  diagnosis.  He  also  can  give  his  atten- 
tion to  looking  up  the  literature  of  cases  which 
are  being  studied  and  to  the  investigation  of 
the  newest  methods  of  treatment. 

The  equipment  necessary  for  applying  the 
modern  methods  of  clinical  diagnosis  is  neither 

299 


MEDICAL    SOCIOLOGY 

formidable  nor  out  of  the  reach  of  the  general 
practitioner.  It  does  not  require  a  complicated 
laboratory,  although  a  laboratory  is  desirable. 
A  table  for  a  microscope  and  its  appurtenances 
is  necessary.  If  there  are  no  rooms  adjacent 
to  the  consulting  room,  a  small  incubating  oven 
may  be  set  up  in  the  kitchen.  The  apparatuses 
for  blood  counting  and  for  determining  blood 
pressure  should  be  added  to  the  clinical  ther- 
mometer and  the  stethoscope.  The  important 
examinations  to  be  made  are  of  the  sputum,  the 
urine,  stomach  contents,  feces,  the  blood,  and 
bacteriological  tests  of  mucous-membrane  dis- 
charges. The  young  men  who  are  now  being 
sent  out  to  practice  medicine  have  been  taught 
these  things,  and  they  should  practice  them. 
The  best  conditions  of  general  practice  are 
served  when  the  busy  practitioner  associates 
with  him  such  a  man.  Their  mutual  interests 
will  be  helped.  It  is  universally  true,  other 
things  being  equal,  that,  the  better  work  a  phy- 
sician does,  the  better  are  his  emoluments. 

We  must  return,  in  a  measure,  to  the  old  sys- 
tem of  preceptor  and  pupil ;  the  latter,  however, 
being  a  licensed  and  scientific  physician  who 
gives  as  much  as  he  receives.  He  should  give 
his  services  as  an  assistant  in  the  lines  above 

300 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

referred  to.  He  also  may  be  called  upon  to  do 
some  of  the  night  work,  to  do  dressings,  admin- 
ister anaesthetics,  and  in  many  other  ways  to 
lighten  the  burdens  of  the  senior,  and  in  so  do- 
ing help  out  his  own  income  and  lay  the  founda- 
tion for  his  future  work.  The  latter  can  con- 
tribute the  lessons  which  experience  has  taught. 
He  can  give  his  assistant — or,  preferably,  asso- 
ciate— the  benefit  of  that  combination  of  knowl- 
edge, skill,  tact,  and  judgment  which  the  schools 
cannot  teach,  and  which  can  only  be  developed 
by  time,  and  well-guided  experience;  it  is  the 
atmosphere  that  surrounds  the  ideal  physician. 
He  can  turn  over  to  his  associate  cases  which  he 
prefers  not  to  treat. 

The  same  younger  man  may  be  associated 
with  two  or  more  physicians  if  one  has  not  suf- 
ficient work  to  keep  him  busy.  As  the  younger 
man  becomes  more  and  more  engaged  with  gen- 
eral practice  he  will  give  less  time  to  the  labora- 
tory, but  it  is  surprising  how  habits  of  accuracy 
in  diagnosis  cling  to  a  man  who  has  once  prac- 
ticed them.  It  is  also  surprising  how  difficult 
it  is  for  a  man,  who  starts  in  practice  "  by  the 
rule  of  thumb,"  to  get  away  from  his  careless 
habits.  About  the  worst  thing  that  can  happen 
to  a  young  man  is  to  enter  immediately  into  a 

301 


MEDICAL   SOCIOLOGY 

large  and  driving  general  practice  before  he 
has  had  a  chance  to  get  himself  squarely  ori- 
ented with  regard  to  general  medical  work. 
The  best  results  are  to  be  secured  by  gradually 
growing  out  of  the  clinical  laboratory  and  the 
deliberate  and  leisurely  study  of  cases  into  gen- 
eral practice. 


XIX 

WORK    AND   PLAY 

LET  it  be  laid  down  as  a  rule  of  life  that 
a  man  should  not  be  addicted  too  much 
^  to  any  one  thing.  The  wisdom  of  a 
wholesome  variety  and  the  mixing  of  play  with 
work  should  drive  the  busy  man  afield  in  cer- 
tain seasons  of  the  year  in  search  of  change  and 
recreation.  To  none  do  these  observations  ap- 
ply more  than  to  the  dweller  in  the  city,  and  to 
no  dweller  in  the  city  more  than  to  the  doctor 
of  medicine.  He  lives  and  works  in  an  atmos- 
phere of  stress,  and  he  cannot  help  himself  be- 
ing influenced  by  it.  He  is  surrounded  by  the 
rush  for  gain  and  power,  which  he  cannot  help 
from  entering  into  his  blood.  About  him  is  the 
strenuous  business  life, 

Where  with  like  haste,  thro'  diff'rent  ways  they  run, 
Some  to  undo,  and  some  to  be  undone. 

The  city  life  is  an  unnatural  life.    It  lacks 
the  recreation  to  be  found  in  manual  toil.    The 
31  303 


MEDICAL    SOCIOLOGY 

surgeon  uses  his  hands,  to  be  sure,  but  his  work 
is  associated  with  so  much  personal  responsi- 
bility and  nervous  strain  that  the  real  hygienic 
advantage  to  the  worker  is  neutralized.  The 
average  city  business  or  professional  man,  if 
he  is  wise  and  fortunate  for  a  season  turns  his 
back  upon  this  scene  of  artificial  life,  and  seeks 
the  places  which  men  have  not  defiled.  Let 
him  go  where  he  will  look  up  to  the  blue  sky — 
I  shall  not  say  can,  for  he  can  look  up  to  it  in 
town  if  he  only  would — and  let  him  roam  the 
fields  or  woods  or  sea;  and  he  will  be  a  better 
doctor  for  it,  and  his  patients  will  receive  bet- 
ter advice  when  he  returns. 

There  are  many  diversions  which  are  helpful 
to  the  practice  of  medicine — riding,  driving, 
walking,  the  outdoor  games,  and  working  with 
the  hands.  They  are  all  there,  waiting  for  the 
man  who  will  let  them  take  hold  of  him  and 
help  him.  As  to  fishing,  the  best  way  to  fish  is, 
Tityruslike,  to  lie  beneath  the  shadow  of  the 
branches  of  a  widespreading  beech,  and  read 
the  "  Complete  Angler."  Walking  has  much 
to  recommend  it.  It  is  an  ancient  pastime. 
Among  our  primitive  ancestors  it  was  culti- 
vated as  the  most  approved  means  of  travel. 
To  those  of  the  equipage  and  the  motor  car,  I 

304 


MEDICAL   SCIENCE    AND   MEDICAL   AET 

commend  it.  Take  with  you  the  society  in 
which,  of  all  the  world,  you  find  the  greatest 
joy,  and  walk  the  fields,  breathe  deeply,  inhale 
the  breath  of  flowers,  behold  the  pictures  na- 
ture has  made,  listen  to  the  songs  of  birds ;  and 
when  you  return  to  work  you  will  radiate  joy 
just  in  the  proportion  that  you  have  absorbed 
it  out  of  the  great  world  of  beauty  in  which  you 
have  sojourned. 

The  country  practitioner  leads  a  more  round- 
ed life.  He  is  less  apt  to  be  addicted  too  much 
to  any  one  thing.  He  has  his  wholesome  diver- 
sions. Some  of  these  diversions  his  city 
brother,  by  taste  and  education,  or  want  of 
education,  would  not  undertake;  but  they  will 
lengthen  his  days.  Let  the  man  who  puts  out 
his  own  horse  and  trims  his  hedge  after  the 
day's  work  is  done  not  envy  him  who  drops 
into  the  great  upholstered  chair  at  the  club 
around  the  corner  from  his  of&ce  and  fills  the 
circumambient  air  with  rings  of  fragrant  smoke 
at  the  close  of  the  day.  The  city  has  always 
been  the  destroyer  of  men  and  of  families. 
Urhs  edax  rerum.  No  city  would  long  endure 
were  it  not  replenished  with  brawn  and  brains 
from  the  fields  and  mountains. 

Still,  the  country  practitioner  would  profit 
305 


MEDICAL    SOCIOLOGY 

much  by  certain  relaxations  which  he  too  rarely 
takes.  He  needs  the  inspiration  of  the  contact 
with  his  fellows.  He  needs  the  meetings  of  his 
medical  societies  more  than  his  city  brother 
does.  At  such  meetings  he  exchanges  ideas 
with  men  of  larger  experience  and  wider  ob- 
servation than  he.  He  needs  to  have  his  faith 
in  certain  things  corroborated  and  his  doubts  in 
others  confirmed.  The  pleasure  in  his  work 
can  be  much  increased  by  finding  the  ideas 
which  he  has  gained  from  one  case  agreeing 
with  the  experiences  in  a  hundred  others.  What 
has  been  in  his  mind  as  an  unsettled  theory  be- 
comes a  solid  working  fact  through  the  results 
of  others'  observations ;  and  he  goes  back  to  his 
work  with  new  inspirations  and  a  firmer  hold 
upon  the  essentials  of  his  art. 

As  the  practice  of  medicine  goes,  most  practi- 
tioners devote  themselves  so  assiduously  and 
self-sacrificingly  to  their  work  that  some  form 
of  sporadic  relaxation  does  good  and  helps 
their  minds  and  bodies;  and  in  many  cases 
it  becomes  a  necessity.  Properly  viewed,  this 
is  true,  unfortunately.  The  necessity  for  a  va- 
cation is  an  acknowledgment  that  something  is 
wrong;  and  as  a  matter  of  fact  something  is 
wrong.    Few  men  are  doing  their  work  under 

306 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

the  best  conditions.  This  is  true  because  there 
are  few  men  who  do  not  need  a  vacation,  or  who 
are  not  benefited  by  one. 

There  is  a  Sabbatic  tradition  that  has  come 
down  to  us  from  remote  times.  This  tradition 
has  become  a  part  of  our  religion  and  entered 
into  the  laws  of  the  state.  But  it  is  not  well 
founded.  It  is  unnatural  that  a  man  should 
conduct  himself  for  six  days  in  such  a  manner 
that  at  the  end  of  that  time  he  needs  a  day's 
rest  from  his  doings  of  the  other  six.  Still, 
most  of  us  do.  How  much  better  it  would  be 
if  we  might  live  so  that  on  Tuesday  morning 
we  should  begin  work  as  much  refreshed  as  on 
Monday,  and  Saturday  should  find  us  as  ready 
for  labor  and  play  as  Wednesday  had,  and  that 
our  services  and  thoughts  might  be  as  holy  on 
each  day  of  the  seven  as  we  could  make  them. 
This  would  be  the  equable  life,  which  we  have 
not  yet  learned  to  live. 

The  average  professional  and  business  man 
must  have  his  summer  vacation ;  he  shortens  his 
life  without  it.  Essentially,  it  is  not  the  sum- 
mer vacation  that  is  so  good,  it  is  the  preceding 
months  of  work  that  are  so  bad.  He  has  vio- 
lated the  laws  of  health:  the  vacation  is  the 
therapy;  he  takes  it  as  a  cure  to  save  his  life. 

307 


MEDICAL    SOCIOLOGY 

Better  that  he  should  not  need  the  cure ;  proph- 
ylaxis is  the  thing. 

Let  us  hope  that  we  may  attain  to  that  state 
in  which  work  and  play  and  prayer  and  medi- 
tation shall  be  so  harmoniously  combined  and 
progress  together  so  smoothly  and  naturally 
that  a  surcease  from  our  method  of  life  need 
never  be  a  necessity.  Then  shall  each  day  of 
the  seven  have  its  Sabbath  hours,  each  day  of 
the  summer  and  winter,  too,  its  portion  of  va- 
cation; and  so  in  all  the  days  and  seasons  of 
the  year,  the  stream  of  life  shall  flow  smoothly 
on  toward  the  great  sea  of  eternity. 

And,  furthermore,  let  it  be  provided  always 
that  no  useful  man  shall  envy  the  man  who  has 
a  great  stock  of  health  and  nothing  more. 


A   WELL-OEDERED   LIFE 

WHEN  a  man  is  found  who  orders  his 
life  pretty  close  to  the  ideal  it  is 
well  to  take  cognizance  of  him.  I 
know  a  man,  a  practitioner  of  medicine,  yomig 
and  strong  at  sixty-two,  who  lives  the  normal 
life — at  least  as  nearly  as  it  is  possible  for  a 
practitioner  of  medicine  to  live  it  surrounded 
by  a  community  of  violators  of  the  code  of  na- 
ture's ethics.  He  sees  as  many  patients  each 
day  as  time  will  permit,  giving  each  one  as 
much  attention  as  though  he  were  the  only  case 
he  had.  He  saves  time  by  choosing  his  friends 
among  the  most  congenial,  not  among  his  pa- 
tients. He  never  makes  a  companion  of  a  pa- 
tient for  policy's  sake.  He  "  sits  around  "  nei- 
ther in  the  sick  room  nor  in  the  drug  store.  He 
prefers  not  to  be  called  where  he  is  expected  to 
entertain  the  family  or  consult  with  the  grand- 
mothers. He  chooses  his  companions  among 
the  well.    He  is  one  of  the  best-posted  men  that 

309 


MEDICAL    SOCIOLOGY 

I  know;  and  his  judgment  and  learning  make 
him  sought  by  many  a  colleague  who  desires 
to  get  at  the  heart  of  a  case.  His  library  is 
well  stocked  with  the  best  current  medical  liter- 
ature and  books  of  reference.  Usually  he  has 
a  young  practitioner  associated  with  him.  In 
a  small  laboratory  connected  with  his  office  the 
finer  details  of  diagnosis  receive  attention.  He 
has  the  newest  apparatuses  of  accuracy,  but 
whenever  possible  he  prefers  to  depend  upon 
the  old  and  tried  blunt  methods.  He  can  hear 
almost  as  much  with  his  naked  ear  as  with  the 
stethoscope.  Still  he  keeps  his  associate  pretty 
busy  making  microscopic  examinations. 

This  man  received  much  of  his  early  medical 
education  under  the  masters  of  Europe  thirty- 
five  years  ago,  yet  he  attempts  no  specialty; 
even  minor  surgery  he  delegates  to  some  one 
else.  He  keeps  well  posted  upon  the  advances  in 
the  specialties,  and  hnoivs  what  they  can  do  for 
his  patients.  He  sees  a  comparatively  large 
number  of  patients  each  day,  and  possesses  a 
wonderful  store  of  formulated  knowledge  based 
on  experience.  He  is  a  regular  attendant  at  his 
medical  societies,  where  his  discussions  are  al- 
ways models  of  clearness  and  scientific  thought. 
He  thoroughly  enjoys  his  work,  and  still  finds 

310 


MEDICAL   SCIENCE    AND   MEDICAL   ART 

as  much  pleasure  in  getting  at  a  diagnosis  as 
he  ever  did  in  his  student  days.  He  still  re- 
gards himself  in  every  sense  a  student. 

So  much  for  this  man  at  work:  he  is  not  so 
very  different  from  many  of  our  high-class 
practitioners ;  but  at  play  he  is,  for  I  know  no 
man  who  brings  such  a  happy  philosophy  into 
all  the  hours  of  the  day.  He  is  one  of  the  sweet- 
est, most  courteous,  and  fragrant  characters; 
and  in  every  sense  a  gentleman.  Above  all,  he 
is  original.  He  insists  that  his  family,  and  even 
himself,  are  a  part  of  the  community  which  is 
entitled  to  his  best  thought  and  attention,  as 
well  as  the  sick.  The  sick  summon  him  because 
they  regard  him  as  the  best  doctor  to  get  them 
well;  but  his  own  call  him  because  they  love 
him.  For  certain  hours  during  the  day  this 
good  man  devotes  himself  to  the  well,  I  know 
that  he  himself  practically  prepared  one  of 
his  sons  and  a  daughter  for  college;  and 
they  all  thought  it  was  play.  At  the  present 
time  he  has  a  class  in  biology  and  natural  his- 
tory, and  the  two  oldest  pupils  are  himself  and 
his  grandson,  aged  eight.  I  met  them  coming 
in  from  the  suburbs  one  morning  before  break- 
fast with  a  can  of  tadpoles  and  half  a  dozen 
frogs  in  an  old  medicine  bag.    I  do  not  know 

311 


MEDICAL    SOCIOLOGY 

where  he  got  them,  but  he  said  that  he  was 
taking  them  to  his  Sunday  school. 

He  loves  his  children  and  grandchildren.  He 
recognizes  children  as  our  best  teachers.  The 
responsibilities  which  they  bring  make  us  bet- 
ter. They  teach  us  self-denial  and  considera- 
tion for  others.  He  says  that  children  are  the 
real  missionaries  that  are  redeeming  the  world. 

He  is  one  of  the  boys  with  the  boys.  I  saw 
him  once  with  three  grandchildren  on  his  back, 
playing  in  the  very  middle  of  the  day,  and  his 
wife  threatened  with  apoplexy  from  laughter; 
and  I  happened  to  know  that  at  that  time  there 
were  four  peo]Dle  trying  to  find  him.  When  he 
is  not  in  his  office  his  servants  know  that  he  is 
not  in ;  and  when  he  is  occupied  with  his  family 
he  is  just  as  occupied  as  though  he  were  with 
the  sick.  He  recognizes  his  duty  to  them  and 
to  himself,  and  he  claims  that  it  makes  him  a 
better  doctor.  By  doing  well  by  the  well  he  is 
better  able  to  do  so  by  the  sick.  He  has  a  gar- 
den full  of  flowers,  a  house  full  of  happiness, 
and  a  heart  full  of  love  for  all  the  things  in 
nature.  The  curious  part  of  it  is  that  each  day 
in  the  seven  is  the  same,  and  he  has  never  taken 
a  vacation  because  he  needed  it. 

The  work  of  this  good  man  is  among  all 
312 


MEDICAL   SCIENCE    AND   MEDICAL   ART 

classes  of  people — from  the  very  rich  to  the 
very  poor.  To  whomever  he  goes  he  gives  his 
best  thought,  and  faithful  and  conscientious 
service,  whether  paid  in  money  or  in  some  bet- 
ter currency.  He  is  loved  by  all  of  these,  and 
respected  and  honored  by  his  profession.  Grad- 
ually an  undesirable  class  of  patients  has  be- 
come estranged  from  him — those  who  want  to 
take  medicine — for  he  is  one  of  the  few  men 
in  his  community  who  often  see  a  case  through 
an  illness  without  resorting  to  the  drug  store 
at  all.  Sometimes  his  advice  to  patients  dis- 
plays so  sharp  an  insight  into  their  characters 
and  habits  that  they  seek  some  other  adviser 
who  will  be  more  impersonal.  This,  together 
with  his  disinclination  to  spend  time  over  the 
trivialities  with  unprofitable  people,  has  kept 
his  practice  down  to  a  comfortable  working 
basis.  Most  of  the  men  who  were  his  contem- 
poraries in  early  practice  have  passed  away, 
and  during  their  last  few  years  many  of  them 
were  inefficient  from  overwork.  This  man  is  a 
better  doctor  to-day  than  he  ever  was.  He  is 
like  an  oak  which  buffets  the  storms  and  basks 
in  the  sun,  and  is  the  same  from  day  to  day. 
He  has  no  ups  and  downs,  because  he  is  always 
up.    In  the  community  he  is  a  public-spirited 

313 


MEDICAL    SOCIOLOGY 

citizen,  taking  an  active  share  in  politics  and 
devoting  mucli  time  to  educational  work.  He 
is  a  member  of  the  local  school  board,  and  has 
been  instrumental  in  the  inauguration  of  school 
methods  that  have  attracted  wide  attention. 

Now  for  the  strangest  thing  of  all.  The  one 
class  of  people  who  profess  love  and  charity 
shrug  their  shoulders  when  asked  about  this 
man,  and  many  have  no  good  word  for  him,  ex- 
cept that  they  hear  he  is  a  good  doctor.  Good 
doctor,  forsooth!  What  better  can  be  said  of 
any  man?  He  is,  indeed,  a  good  doctor;  his  re- 
wards he  reaps  each  day;  and  he  is  paving  a 
path  to  immortality  strewn  with  flowers  of 
sweetest  perfume  and  echoing  with  the  music 
of  the  voices  of  children. 


XXI 

THE   PHYSICIAN    IN    POLITICS 

EVEEY  physician  has  been  advised  to 
keep  out  of  politics.  This  advice  cannot 
be  escaped.  The  Commencement-day 
orator  delivers  it  to  the  graduating  class,  the 
old  physician  cautions  the  young  man  against 
"  mixing  in  politics,"  the  literature  of  medicine 
perpetuates  the  admonition,  and  medical  circles 
have  a  perennial  sneer  for  the  "  political  doc- 
tor." It  is  to  be  wished  that  there  might  be  less 
of  this  sentiment.  It  is  neither  fair  to  the  state 
nor  to  the  medical  profession:  it  deprives  the 
former  of  the  interest  of  one  of  its  best  class  of 
citizens,  and  the  latter  of  the  advantages  of 
availing  itself  of  the  opportunities  of  self-gov- 
ernment. To  advise  any  class  of  citizens  to  ab- 
stain from  politics  is  to  advise  self-disfran- 
chisement. 

Politics  is  the  science  and  practice  of  gov- 
ernment.   It  is  "  clean  "  or  "  dirty,"  as  the  peo- 

315 


MEDICAL    SOCIOLOGY 

pie  who  participate  are  clean  or  dirty.  No 
class-day  orators  are  advising  the  dive-keeper 
or  the  man  who  preys  upon  the  lives  and  prop- 
erty of  the  people  to  keep  out  of  politics;  as  a 
matter  of  fact  he  is  thoroughly  in  it,  and  has 
more  legislation  influenced  in  his  interest,  and 
places  more  of  his  friends  in  office  in  one  year 
than  the  medical  profession  does  in  ten  years. 
This  is  partly  due  to  class-day  oratory,  and  to 
the  superior  attitude  and  aloofness  of  our  pro- 
fession. 

The  science  of  medicine  has  brought  about 
as  far  as  it  can  the  solution  of  the  tuberculosis 
problem  and  the  typhoid  fever  problem  and  a 
host  of  other  similar  problems  which  are  as 
vital  to  the  people  as  are  the  lives  of  their  chil- 
dren. Medicine  has  shown  how  these  diseases 
may  be  exterminated.  Now  these  matters  are 
up  to  the  state.  That  means  their  further  de- 
velopment is  in  the  hands  of  politics.  And  shall 
our  profession,  after  having  hunted  down  the 
monster  of  typhoid,  and  gotten  it  at  bay  in  its 
lair,  cowed  and  at  our  mercy,  desist  from  giving 
the  coup  de  grace  because  the  stroke  must  be 
applied  with  the  lance  of  politics!  We  need 
more  doctors  in  our  legislative  chambers  and  in 
our  executive  offices.     Medicine  has  long  ago 

316 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

grown  past  tlie  function  of  administering  to 
those  who  perchance  have  fallen  sick.  It  has 
become  the  most  salutary  field  of  activity  in  the 
commonwealth,  and  we  are  not  raising  up  men 
fast  enough  to  administer  its  offices.  We  may 
justly  be  accused  of  slothfulness  in  our  duty  to 
the  people. 

There  are  a  large  number  of  cities  in  this 
country  in  which  the  best-administered  office  is 
the  department  of  health  under  medical  super- 
vision, but  in  many  municipalities  this  impor- 
tant department  is  handicapped  by  an  absence 
of  medical  influence  in  the  bodies  to  which  it  is 
answerable.  In  legislative  matters  the  medical 
man  can  be  counted  on  to  be  on  the  right  side 
of  the  great  questions  concerning  the  health  of 
the  people,  and  he  is  the  only  legislator  of  whom 
this  can  be  said.  We  strive  for  wise  medical 
laws,  we  are  confronted  by  the  urgent  need  of 
a  national  department  of  health,  but  in  order 
to  secure  these  benefits  for  the  people  we  have 
to  appear  as  suppliants  before  the  legislative 
bodies,  which  are  often  without  sympathy  or  ap- 
preciation of  the  meaning  of  these  things.  The 
few  physicians  in  these  bodies  are  of  great  help. 
But  the  United  States  Congress,  made  up  of  476 
members,  contains  only  four  physicians;  that 

317 


MEDICAL    SOCIOLOGY 

is,  one  physician  to  represent  every  22,000,000 
of  inhabitants,  including  130,000  educated  phy- 
sicians. 

In  the  minor  municipal  offices  we  find  phy- 
sicians. Usually  these  men  are  selected  by  the 
civil-service  system.  They  represent  a  high 
grade  of  culture  in  the  municipal  service,  and 
the  city  is  fortunate  in  having  them.  The  num- 
ber of  offices  which  can  be  filled  only  by  medi- 
cal men  is  constantly  increasing  and  will  con- 
tinue to  increase.  Medicine  is  destined  to  play 
a  role  in  politics  which  it  is  not  difficult  to  fore- 
see, and  it  behooves  us  to  prepare  for  it,  and 
not  hold  aloof  from  the  duties  and  opportuni- 
ties which  the  future  has  in  store. 

If  the  medical  man  can  afford  to  give  some 
of  his  time  or  substance  to  charity  or  philan- 
thropy, as  all  physicians  do,  he  can  employ  his 
energies  in  no  better  channel  than  in  labor  for 
the  common  good,  for  social  and  civic  better- 
ment, through  the  agency  of  politics.  Govern- 
ment is  not  in  the  hands  of  the  people — it  is  in 
the  hands  of  the  people  who  take  it  into  their 
hands.  In  Germany,  France,  and  England, 
physicians  take  a  prominent  part  in  political 
matters  and  in  the  general  interests  of  the  com- 
munity.    In  the  early  period  of  this  country 

318 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

medical  men  were  active  in  the  affairs  of  gov- 
ernment. We  may  name  with  pride  Benjamin 
Ensh,  Josiah  Barttall,  Oliver  Wolcott,  Lyman 
Hall,  Matthew  Thornton,  Edward  Hand,  Wil- 
liam Irvine,  Jonathan  Arnold,  Cadwallader 
Golden,  John  Brooks,  William  Eustis,  Nathan- 
iel Freeman,  Joseph  Warren,  and  Hugh  Mer- 
cer— physicians  who  made  their  impression 
upon  the  politics  of  their  time.  Among  the 
finest  features  of  the  history  of  medicine  in 
this  country  are  the  signatures  of  the  doctors  of 
medicine  to  the  Declaration  of  Independence. 
Of  them  we  should  be  proud.  Political  doctors, 
they! 


22 


XXII 

KNOWLEDGE   VERSUS    MANNERS 

THERE  is  no  substitute  for  knowledge. 
There  is  no  imitation  knowledge. 
Knowledge  is  either  the  real  thing  or  it 
is  not  knowledge. 

I  should  like  to  see  this  proposition  impressed 
upon  every  student  early  in  his  career.  Com- 
mencement addresses  are  prone  to  exalt  the 
manners  of  the  phj^sician.  Cultivate  an  ele- 
gant, hopeful  and  gracious  sick-room  manner,  it 
will  do  more  than  all  your  medical  knowledge, 
they  say.  Maybe  it  will ;  but  if  that  is  the  case, 
the  patient  does  not  need  a  doctor. 

I  have  heard  this  so  often  and  seen  so  much 
of  the  pernicious  effects  of  this  teaching  that  I 
am  convinced  that  a  voice  should  be  raised  in 
the  defense  of  sick-room  knowledge  against 
sick-room  manners.  There  are  two  things 
which  the  doctor  should  take  with  him  to  the 
sick  room:  the  spirit  of  the  scientist  and  the 
spirit  of  the  gentleman,  relatively  important  in 

320 


MEDICAL   SCIENCE   AND   MEDICAL   ART 

the  order  named.  The  art  of  medicine  is  a  com- 
bination of  these  two.  If  a  man  is  truly  imbued 
with  the  former,  the  latter  follows  as  a  neces- 
sary result.  A  man  may  be  a  successful  engi- 
neer or  electrician  and  not  a  gentleman ;  but  the 
medical  man  touches  human  life  too  closely  not 
to  be  a  gentleman  if  he  is  to  be  successful.  The 
physician  who  applies  his  science  to  the  best 
purpose,  to  the  end  of  curing  his  patient,  cannot 
deport  himself  in  any  manner  derogatory  to  the 
interests  of  his  patient.  It  is  not  a  scientific 
application  of  medicine  for  the  physician  to  be 
brusque  and  unmannerly  in  the  presence  of  a 
sensitive  sick  person  whom  he  essays  to  help. 
The  scientific  spirit  in  therapeutics,  knowledge 
of  the  effects  of  external  influences  upon  the 
disease,  is  what  the  physician  should  take  with 
him  into  the  chamber  of  the  sick.  These  are 
the  essentials. 

I  have  endeavored  to  define  the  essentials  of 
our  art,  as  contrasted  with  the  outward  graces 
which  certain  practitioners  exalt  above  them. 
Happily  among  regular  practitioners  the  culti- 
vation of  the  manner  is  rarely  at  the  expense  of 
the  essentials,  but  among  certain  physicians  it 
is  carried,  unfortunately,  to  an  extreme  degree. 
The  clanking,  silver-trimmed  harness,  or  the 

321 


]\rEDICAL    SOCIOLOGY 

limousine,  the  rose  in  the  button-hole,  dia- 
monds, the  patent-leather  ties,  the  elegant  and 
imposing  manner  in  the  sick  room,  with  the 
well-turned  and  flattering  allusions,  may  be  all 
delightful  and  helpful  and  good,  but  pity  the 
patient  if  they  be  at  the  expense  of  the  scien- 
tific medical  essentials  if  the  patient  be  really 
sick.  The  man  who  would  refrain  from  listen- 
ing to  a  patient's  chest  sounds  because  it  cannot 
be  done  in  a  dignified  way,  or  who  is  thinking  of 
his  own  manners  when  he  should  be  thinking  of 
the  patient,  has  no  place  in  medicine. 

Many  a  young  man,  after  admonitions  on 
manners  from  some  wise  head,  is  prompted  to 
have  his  trousers  pressed,  invest  in  an  orchid, 
and  cultivate  a  pink-tea  smirk  to  carry  with  him 
into  the  sick  room ;  when  it  would  be  better  for 
his  patient  did  he  but  render  his  trousers  baggy 
with  his  knees  under  his  microscope,  and  wear 
upon  his  face  into  the  sick  room  the  simple  ex- 
pression of  intelligent  interest  and  hope  bom  of 
knowledge  and  confidence. 

Much  is  said  of  the  physician  inspiring  con- 
fidence. To  a  certain  degree  it  is  a  good  thing. 
It  is  not  necessarily  the  badge  of  the  competent 
doctor,  but  it  is  the  stock  in  trade  of  the  char- 
latan.   The  latter  is  always  full  of  confidence. 

322 


MEDICAL   SCIENCE    AND   MEDICAL   ART 

He  assures  his  patient  that  he  will  cure  him. 
His  income  depends  upon  inspiring  confidence. 
He  is  the  beau  ideal  confidence  man.  The  phy- 
sician who  inspires  confidence  usually  inspires 
it  because  his  patient  is  a  strong  man  or  is  not 
profoundly  sick.  But  after  all,  the  best  confi- 
dence in  the  sick  room  is  the  confidence  in  the 
ability  of  the  doctor,  in  his  interest  in  the  case, 
and  in  the  belief  that  he  will  do  all  that  he  can 
for  the  patient. 

"  There,"  said  the  doctor,  as  he  flicked  the 
powder  upon  the  patient's  tongue.  It  was  the 
"  there  "  that  did  the  patient  more  good  than 
the  powder,  was  it?  So  much  the  worse  for  the 
powder,  so  much  the  better  for  the  patient ;  the 
powder  was  not  much  good  or  the  patient  was 
not  much  sick,  one  or  the  other  or  both.  This 
matter  of  manners  is  exalted  because  most  pa- 
tients would  get  along  pretty  well  without  medi- 
cal attention,  and  the  beneficent  manners  of 
which  we  hear  so  much  would  become  any  one 
better  than  they  do  the  doctor.  It  is  because 
his  work  is  to  so  large  an  extent  among  those 
who  do  not  need  him  for  his  medical  attain- 
ments that  the  notion  has  become  current.  Its 
positive  harm  comes  when  habit  has  prompted 
him  to  cultivate  manners  and  when  he  permits 

323 


MEDICAL    SOCIOLOGY 

them  to  interfere  with  the  essentials  in  a  case 
which  needs  the  best  his  brains  and  his  science 
can  give.  Then  we  realize  the  meaning  of  the 
true  doctor.  Then  we  appreciate  the  man  who 
has  piled  up  as  much  knowledge  as  he  can,  who 
brings  it  to  the  bedside,  who  applies  the  scru- 
tiny of  the  well-trained  mind,  who  goes  at  his 
case  with  method,  whose  aim  is  first  to  discover 
the  nature  of  the  disease  and  then  apply  the 
treatment  with  recovery  as  the  goal,  and  who 
adds  to  these  qualities  the  simple  attributes  of 
an  honest  and  gentle  man. 


XXIII 

MEDICAL   LIBRAKIES 

A  MEDICAL  community  with  a  medical 
society  is  invariably  progressive;  but 
if  it  adds  to  this  a  good  medical  li- 
brary, it  adds  to  its  progressiveness  stability. 

A  hospital,  a  laboratory  or  a  society  is  often 
the  nucleus  of  interest  about  which  a  medical 
community  gathers,  but  none  of  these  can  ap- 
peal so  strongly  to  the  largest  number  of  the 
substantial  element  of  the  profession  as  does  a 
medical  library.  One  of  the  reasons  for  this  is 
that  a  medical  library  is  not  possible  in  a  com- 
munity which  is  not  sufficiently  advanced  to 
have  a  successful  medical  society.  The  hospital 
and  the  laboratory  in  a  given  community  do  not 
offer  like  opportunities  to  all,  and  the  voice  in 
their  management  and  work  comes  from  but  a 
few. 

A  society  is  influenced  by  the  indescribable 
"  spirit  of  the  hive  "  or  by  some  dominant  char- 
acter, and  its  interests  rise  and  fall,  unless  it  be 

325 


MEDICAL    SOCIOLOGY 

a  great  organization  or  has  property  interests 
or  vested  rights  affecting  its  members.  But  a 
medical  library  in  Trhich  all  members  have  a 
right  and  which  depends  for  its  existence  upon 
the  interest  of  all,  when  once  established  and 
appreciated,  becomes  a  center  of  common  sym- 
pathy and  the  strongest  of  bonds  for  holding  a 
medical  organization  in  harmony. 

A  society  with  such  a  library  possesses  co- 
hesive power.  Men  who  are  advanced  enough 
to  maintain  a  society  will  often  rally  about  the 
interests  of  a  library  when  but  passive  in  other 
things.  They  may  have  their  differences  in  the 
hospital  and  in  the  society,  but  they  will  be 
found  united  for  the  library.  Such  a  library 
becomes  their  pride.  They  know  its  worth. 
Their  common  interests  crystallize  about  it.  It 
diffuses  through  the  whole  society  high  ideals,  a 
respect  for  that  which  is  scholarly  and  worthy 
of  reverence,  and  a  love  for  the  noble  traditions 
of  their  profession. 

Asa  library  develops  and  grows  it  should  add 
in  the  order  named  the  following  classes  of  lit- 
erature: First,  the  current  periodicals;  second, 
the  newer  books;  third,  the  completed  sets  of 
periodicals  and  reports;  and  fourth,  the  older 
works — the  writings  of  the  fathers — in  which 

326 


MEDICAL   SCIEJs^CE    AND   MEDICAL   AET 

glimmer  the  begimiings  of  the  art  and  science 
of  medicine.  Every  medical  community  should 
have  a  library  begun  and  developed  on  these 
lines. 

It  would  be  possible  for  every  county  society 
or  other  county  organization,  to  which  all  phy- 
sicians are  eligible,  to  have  its  medical  library. 
In  sparsely  settled  coimties  the  library-sup- 
porting organization  might  be  geographically 
larger.  Physicians  are  learning  the  value  of 
community  of  interests.  There  is  no  need  of 
five  doctors  in  a  single  village  all  having  a  com- 
plete set  of  the  same  reference  work  when  none 
of  them  has  some  other  thing  which  is  of  just 
as  much  importance.  It  would  be  wiser  if  they 
pooled  their  interests ;  and  then,  with  the  same 
amount  of  money,  they  could  have  five  different 
things  instead  of  one.  The  next  step  is  short: 
it  is  the  establishment  of  a  central  place  where 
these  things  shall  be  available  to  all.  "When 
that  step  is  taken  the  development  of  a  library 
with  its  beneficent  influence  is  begun.  A  little 
attention  keeps  it  alive,  and  the  forces  of  nature 
feed  it. 

It  only  requires  a  word,  here  and  there,  to 
turn  into  it  the  library  of  a  deceased  physi- 
cian, which  otherwise  would  be  dissipated  and 

327 


MEDICAL    SOCIOLOGY 

ultimately  find  its  way  to  the  junk  shop.  A 
little  cooperation  with  a  neighboring  library 
exchanges  duplicates  for  things  needed.  The 
American  Association  of  Medical  Librarians 
conducts  a  clearing  house  for  just  this  purpose. 
Time  is  the  all-important  factor  in  the  growth 
of  a  library.  A  library  which  is  kept  sound  is 
as  sure  to  grow  as  an  oak  sapling.  It  is  hard 
to  stop  it.  One  of  the  greatest  libraries  in  this 
country,  that  of  the  College  of  Physicians  of 
Philadelphia,  organized  when  Philadelphia  was 
a  village,  can  be  pointed  to  as  a  product  of  time. 
For  nearly  two  centuries  medical  books  have 
gravitated  to  it,  until  now  it  is  a  veritable  treas- 
ure-house of  medical  literature.  Time  does  it. 
The  community  which  contemplates  organizing 
a  library  is  squandering  its  best  capital  in  delay. 

The  important  factor  in  the  beginning  of  such 
an  undertaking  is  that  every  available  person 
shall  have  an  interest  and  shall  contribute  some- 
thing. A  library  in  a  small  community  to  which 
everybody  contributes  two  dollars  a  year  is 
worth  twice  as  much  as  one  in  which  the  same 
total  sum  is  contributed  by  one  or  a  few  indi- 
viduals. "  Our  Library "  is  the  talisman  of 
success. 

It  is  to  be  hoped  that  the  smaller  cities  and 
328 


MEDICAL   SCIENCE    AND   MEDICAL   ART 

rural  districts  will  establish  libraries  among 
which  the  spirit  of  cooperation  may  move,  mitil 
the  country  is  dotted  with  these  storehouses  of 
medical  learning,  and  each  community  becomes 
a  permanent  custodian  of  the  literature  of  med- 
icine. 


XXIV 

THE   HISTORY   OF   MEDICINE 

THAT  doctor  is  best  qualified  to  practice 
his  profession  in  whom,  other  things 
being  equal,  is  found  a  knowledge  of  the 
history  of  his  art.  There  is  no  better  inspira- 
tion to  good  work  than  the  study  of  the  lives 
of  the  pioneers  of  medicine  who  labored  on  to 
success  and  whose  names  live  in  the  annals  of 
our  science.  There  is  no  better  help  for  avoid- 
ing the  pitfalls  of  error  than  an  appreciation  of 
the  struggle  of  scientific  medicine  against  the 
obstacles  of  mysticism,  superstition,  charlatan- 
ism, and  credulity.  The  physician  who  is  not 
familiar  with  the  history  of  medicine  labors  un- 
der a  decided  disadvantage.  How  much  we  hear 
and  how  much  we  read  that  would  not  have  been 
uttered  but  for  a  deficiency  in  this  knowledge! 
The  medical  man  who  is  learned  in  medical  his- 
tory knows  the  origin  of  many  modern  pseudo- 
medical  sects,  and  he  knows  their  fate,  and  is 
best  qualified  to  discover  the  good  in  them. 

330 


MEDICAL   SCIENCE    AND   MEDICAL    ART 

Our  own  country  is  so  young  that  we  have  not 
yet  awakened  to  an  appreciation  of  the  impor- 
tance of  medical  history.  Still,  we  are  old 
enough  to  have  made  some  history  of  our  own 
with  which  every  medical  man  should  be  fa- 
miliar. In  Europe  more  attention  is  given  to 
this  subject.  It  is  taught  in  the  universities  and 
a  large  amount  of  literature  has  accumulated. 
In  the  United  States  there  are  but  few  medical 
schools  which  give  their  students  even  an  ink- 
ling that  medicine  has  a  history.  Much  honor 
is  due  to  the  pioneer  institutions  with  high 
enough  ideals  to  give  lectures  or  instruction  in 
this  field. 

Especially  noteworthy  are  the  medical  his- 
torical societies.  In  such  organizations  we  may 
be  sure  to  find  men  who  represent  the  best  med- 
ical culture  of  their  communities.  American 
medical  literature  may  take  pride  in  the  fact 
that  the  first  periodical  devoted  to  medical  his- 
tory was  established  in  this  country.^  Another 
of  the  advances  which  mark  an  epoch  in  medi- 
cal culture  is  the  action  taken  by  the  University 
of  London  in  1905  requiring  an  examination  in 
the  history  of  medicine  as  essential  for  the  de- 

1  The  Medical  Library  and  Historical  Journal  (now  the  ^scula- 
pian),  instituted  in  1903. 

331 


MEDICAL    SOCIOLOGY 

gree  of  Doctor  of  Medicine.  These  are  all  signs 
of  the  times  pointing  to  the  cultural  growth  of 
medical  knowledge. 

"  The  foundation  stones  of  the  whole  modern 
structure  of  human  wisdom  have  all  been  laid 
by  the  architects  of  yesterday.  Thrice  wise  is 
he  who  knows  the  quarries  and  builders  of  by- 
gone ages  and  is  able  to  differentiate  the  stones 
which  have  been  rejected  from  those  which  have 
been  utilized." 


XXV 

THE    SMALL    MEDICAL    SOCIETY 

"I  hold  every  man  a  debtor  to  his  profession; 
He  should  be  a  help  and  ornament  thereto." — Bacon. 

SOME  of  the  best  inspiration  that  medical 
men  have  ever  received  has  come  from 
the  little  coteries  of  brother  practition- 
ers who  make  np  a  medical  society.  The  large 
societies  serve  their  purpose  and  are  necessary, 
but  the  small  societies,  made  up  of  the  select 
few,  often  supply  inspiration  for  the  members 
which  could  be  created  in  no  other  way.  The 
element  of  mutual  admiration,  engendered  by 
compactness  of  organization,  is  the  important 
thing.  As  a  matter  of  fact  no  man  really  does 
good  work  unless  he  belongs  to  a  mutual  admi- 
ration society  of  some  kind;  it  may  have  only 
two  members ;  but  the  best  work  we  do  is  done 
for  the  approval  of  some  one  else. 

The  small  size  of  a  medical  society  is  no  re- 
proach. If  it  has  sufficient  compactness,  that  is 
closeness  and  harmony,  its  good  cannot  be  meas- 

333 


MEDICAL    SOCIOLOGY 

ured  by  its  size.  The  fact  of  the  existence  of  a 
small  society  implies  that  it  is  successful.  Its 
members  are  so  close  that  if  there  is  lack  of 
sympathy  or  profit  from  its  meetings  it  falls 
apart  and  is  no  more.  All  small  societies  are 
good  societies.  To  designate  such  with  the  ap- 
pellation of  "  mutual  admiration  society,"  is  a 
high  compliment  to  its  members.  If  our  great 
societies  were  tinctured  more  with  mutual  ad- 
miration it  would  be  good.  One  of  the  best 
spirits  that  can  come  among  medical  men  is  that 
of  mutual  admiration,  and  the  little  societies 
often  contain  it  to  an  admirable  degree. 


XXVI 

DOCTOKS'    SONS 

DOCTORS'  sons  pretty  generally  make 
good  doctors;  that  is,  if  they  decide  to 
study  medicine  and  be  doctors  at  all, 
they  succeed.  When  you  hear  a  physician  say 
that  the  practice  of  medicine  is  a  dog's  life,  and 
that  if  he  had  it  to  do  over  again  he  would  never 
study  medicine,  that  patients  are  ungrateful  and 
give  him  little  thanks  or  pay,  you  may  be  pretty 
sure  that  his  son  will  not  study  medicine;  and 
if  perchance  he  should,  he  is  terribly  handi- 
capped by  a  lot  of  bad  medical  traditions.  The 
unsuccessful  doctor  does  not  let  his  son  study 
medicine.  The  doctor's  son  who  does  study 
medicine  is  quite  invariably  the  son  of  the  man 
who  was  successful  enough  to  find  joy  in  his 
work,  and  who  could  wish  his  son  nothing  bet- 
ter than  to  enter  into  the  calling  which  had 
meant  so  much  to  him.  And  the  boy  sees  in  his 
father's  life  something  that  excites  his  admira- 
tion to  emulate  and  covet.  As  a  matter  of  fact 
23  335 


MEDICAL    SOCIOLOGY 

and  observation  the  son  of  the  really  successful 
doctor  commonly  does  study  medicine;  and  I 
could  name  a  number  of  such  men  who  attained 
to  even  greater  success  than  their  fathers. 

However,  the  decision  as  to  whether  a  man  is 
successful  or  not  does  not  rest  with  you  or  me 
— the  decision  is  with  him — he  is  the  only  one 
who  knows. 


XXVII 

TUBERCULOSIS   PREVENTABLE 

IF  tuberculosis  is  preventable,  why  then  is  it 
not  prevented?  Are  not  the  thousands  who 
are  to  perish  during  the  coming  year  worth 
the  saving?  If  we  knew  that  we  should  be 
among  the  number,  should  we  not  think  it  a  ter- 
rible thing?  If  the  treatment  is  simply  hygiene, 
is  it  not  strange  that  we  are  not  willing  to  live 
hygienically  until  after  we  have  contracted  the 
disease?  If  200,000  people  die  annually  of  tu- 
berculosis in  the  United  States,  and  an  equal 
number  are  annually  cured  of  the  disease  by 
sleeping  and  living  in  the  open  air,  why  would 
it  not  have  been  better  for  them  to  have  slept 
and  lived  in  the  open  air  before  they  were  sick, 
instead  of  after  they  were  sick,  and  thus  have 
avoided  the  disease?  If  sleeping  and  living  in 
the  open  air  is  good  for  the  sick  why  is  it  not 
good  also  for  the  well?  Is  it  not  better  to  stay 
well  than  to  be  cured  of  tuberculosis? 


XXVIII 


MEDIEVAL    HISTORY 


IT  is  said  by  some  medical  historians  that  we 
must  remember  that  what  little  Western 
learning  survived  through  the  dark  ages 
was  stored  and  guarded  in  monastic  vaults  and 
clerical  libraries — wealth  imrevealed  and  un- 
known even  to  the  custodians,  but  still  in  some 
fashion  preserved  for  the  enlightenment  of 
wiser  generations — as  though  this  were  to  the 
credit  of  the  Church.  It  made  a  waste  of  Eu- 
rope, and  out  of  the  fertilizing  piles  of  decom- 
posing humanity  grew  its  resplendent  flowers — 
the  mighty  edifices,  which  have  astonished  the 
world.  It  suppressed  natural  scientific  truth, 
for  natural  science  was  contrary  to  its  doc- 
trines. If  anything  was  permitted  to  survive, 
it  was  because  it  was  emasculated  of  such  truths 
as  refuted  its  dogmas;  and  for  this  reason  we 
have  had  preserved  for  us  much  silly  rubbish, 
while  oblivion  has  been  the  fate  of  much  of  the 
real  learning  of  that  unhappy  period,  when  the 
Church  was  dominant. 

338 


XXIX 


SOCIETIES 


IT  is  good  for  men  with,  common  aims  and  in- 
terests to  unite  for  their  mutual  improve- 
ment. The  worker  in  any  field  of  science 
who  has  not  society  affiliation  is  handicapped 
by  the  want  of  it.  Sympathy,  cooperation  and 
help  are  what  everyone  needs,  and  to  deprive 
one's  self  of  them  is  not  independence  but  lack 
of  wisdom.  A  medical  community  in  which  the 
members  are  united  in  a  good  society,  in  the 
success  of  which  they  take  pride,  is  more  pro- 
gressive than  the  community  in  which  each  one 
is  pulling  alone. 

The  doctor  who  needs  the  help  and  sympathy 
of  his  fellows  requires  a  medical  society;  and 
the  independent  worker,  whose  originality  and 
success  make  him  independent,  owes  it  to  his 
fellows  to  affiliate  himself  with  them;  and  each 
will  find  that  there  is  something  for  him  to  give 
and  something  for  him  to  receive. 


XXX 

JUBILEE    MEMBEESHIP 

THE  British  medical  societies  have  a  hap- 
py Custom  of  celebrating  what  they  call 
"  Jubilee  Membership."  When  one  has 
been  a  member  of  a  society  for  fifty  years,  some 
further  cognizance  is  taken  of  this  fiftieth  anni- 
versary than  simply  sending  him  a  bill  for  his 
annual  dues  as  had  been  done  on  forty-nine  pre- 
vious occasions.  Fifty  years  is  a  long  time  for 
a  man  to  have  served  his  profession  and  the 
public;  and  our  British  brethren  observe  this 
by  pausing  for  a  few  moments  in  their  scientific 
work  while  the  president  of  the  society  presents 
a  resolution  congratulating  the  member  upon 
the  attainment  of  his  "  jubilee  membership." 
This  resolution  embodies  congratulations,  a 
brief  resume  of  the  member's  professional  serv- 
ices, and  expressions  of  hope  that  he  may  long 
be  spared  to  the  society  in  the  intellectual  en- 
joyments of  a  ripe  age.  Such  attentions  as  this 
make  for  kindness,  and  sweeten  the  atmosphere 
through  which  we  all  must  walk. 

340 


XXXI 

MEDICAL   PRACTICE    IN    UTOPIA 

MEDICINE  is  the  most  important  of  all, 
and  yet,  because  of  its  inaccuracies, 
it  has  never  taken  its  well  deserved 
place  among  the  sciences.  Medicine  is  the  most 
beneficent  of  all,  and  yet,  because  its  votaries 
must  secure  their  livelihood  by  its  practice,  it 
has  never  taken  its  well  deserved  place  among 
the  philanthropies.  Some  day  it  will,  but  there 
is  to  be  much  education  for  both  doctor  and 
public  before  these  conditions  may  be  realized. 
Medical  practice  in  Utopia  is  different.  Here 
it  is  untrammeled  by  the  necessities  of  the  dol- 
lar. Here  the  doctor  perfects  himself  in  his  sci- 
ence and  art,  and,  with  the  spirit  of  true  philan- 
thropy, advises  his  patient  just  what  is  best  for 
him,  nothing  more  nothing  less ;  that  is  the  only 
consideration;  and  his  reward  is  measured  by 
the  conscientious  devotion,  intelligence,  and 
skill  which  he  puts  into  the  task.  We  have  some 
eminent  practitioners  in  Utopia,  but  many  more 
are  needed. 

341 


XXXII 

THE   PRESENT   DAY 

SOME  practitioners  of  medicine  labor  un- 
ceasingly with  little  diversion  in  their 
work,  looking  forward  to  the  time  when 
they  shall  slacken  their  pace  and  enjoy  surcease 
from  toil.  They  forget  that  the  present  only 
is  surely  ours,  that  the  past  has  gone,  and  the 
future  may  never  come.  He  lives  most  wisely 
who  lives  the  equable  life,  and  finds  his  joys  as 
he  lives  each  day.  Let  us  not  build  a  great  man- 
sion to  occupy  when  we  are  too  worn  out  to 
enjoy  it;  but  instead,  shall  we  not  do  more 
wisely  to  abide  awhile  each  day  in  the  little 
wayside  cottage  of  contentment,  where  the 
morning  glories  creep  over  the  doorway,  and 
the  birds  sing,  and  children  play  merrily  be- 
neath the  boughs? 


XXXIII 

THE   BOKDEKLAND   OF   TKUTH 

IT  is  interesting  to  observe  that  in  many  of 
the  diseases  in  which  scientific  investiga- 
tion has  shown  a  positive  relation  between 
certain  causes  and  effects,  the  discovery  was 
preceded  for  a  long  time  by  a  general  but  uncon- 
firmed surmise  that  such  a  relation  existed. 
There  is  no  belief  or  superstition  but  has  some 
foundation  for  its  existence,  and  many  of  our 
most  important  discoveries  have  been  made  by 
following  crude  surmises. 


XXXIV 

THE   physician's    CALLING 

IF  there  is  any  joy  which  man  should  prize, 
it  is  the  joy  of  relieving  distress.  There  is 
but  one  greater,  and  that  is  the  joy  of  pre- 
venting distress.  The  life  of  the  physician  is 
spent  in  the  midst  of  both  of  these,  and  he 
should  be  the  most  blessed  of  men. 


XXXV 

THE    FUTURE    OF    MEDICINE 

IT  requires  no  extraordinary  insight  to  peer 
into  the  future  and  behold  the  position  of 
exalted  importance  which  medicine  is  des- 
tined to  occupy.  None  of  the  avocations  of  men 
shall  be  more  honored.  Its  administrations 
shall  be  more  kind  and  its  results  more  benefi- 
cent than  philanthropy  itself.  It  shall  stand  be- 
tween the  living  and  the  dead,  and  men  shall 
call  its  mission  holy. 


THE   END 


INDEX 


INDEX 


Accidents  of  Summer,  138. 

Addison,  seduction  in  time  of, 
126. 

iEsculapian,  the,  331. 

Air,  Fresh,  150. 

Alcohol,  a  poison,  60. 
and  college  students,  64. 
and  consumption,  65. 
and  respiratory  diseases,  65. 
and  sexual  vice,  64,  104. 
in  medicine,  61. 

Alcohol  Question,  The,  55. 

Alcoholic  inebriety,  66. 

Alcoholism  not  an  unmitigated 
evil,  57. 

American  Association  of  Medi- 
cal Librarians,  328. 

American  Medical  Association, 
260. 

Aristotle,  214. 

Army,  United  States,  syphilis 
in,  78. 

Arnold,  Jonathan,  319. 

Arnold,  Mathew,  284. 

Assistant,  Clinical,  The  Prac- 
titioner and  the,  299. 

Association  of  American  Medi- 
cal Colleges,  281. 

Automobile  accidents,  136. 


Bacon,  Francis,  333. 

Bacteriology  and  Botany,  211. 

Barton,  W.  M.,  228. 

Barttell,  Josiah,  319. 

Beaconsfield,  Lord,  7. 

Bedroom  ventilation,  161. 

Beginnings    and    Progress    of 
Therapeutics,  221. 

Berkeley,  George,  169. 

Berlin,  prostitution  in,  109. 

Bible,    glorification    of    sexual 
sins  in,  80. 
study  of,  compulsory,  132. 

Biology,  teaching  of,  88,  132, 
263. 

Blaud's  pills,  222. 

Blindness  due  to  venereal  dis- 
eases, 75. 

Borderland  of  Truth,  343. 

Botany,  Bacteriology  and,  211. 

Bourneville,  63. 

Bridge  party,  39. 

Brooks,  John,  219. 

Buckle,  Henry  Thomas,  267. 

Bulkley  on  syphilis  of  the  inno- 
cent, 79. 


Cabinet  of  the  President,  7. 
Calling,  The  Physician's,  344. 


349 


index; 


Cancer  research,  14. 

Cape  Cod,  pneumonia  on,  154. 

Carlyle,  Thomas,  115. 

Child,  responsibility  for,  30. 

Christ,  teaching  of,  173. 

Christian  delusions,  178. 

Christian  Science,  169,  226. 

Christian  teaching,  obsolete, 
263. 

Church,  destructive  of  medical 
history,  338. 
should  teach  helpful  truths, 

126. 
teaching  of,  96. 
waning  interest  in  the  super- 
stitions of,  184. 

Cities  breed  idle  women,  119. 

City,  a  trap,  49. 

the  destroyer  of  men,  305. 

City  practitioner,  305. 

Civilization,  Some  Medical 
Aspects  of,  34. 

Clinical  Assistant,  The  General 
Practitioner  and  the, 
299. 

Colden,  Cadwallader,  319. 

Colds  and  fresh  air,  157. 

College  life  and  girls'  educa- 
tion, 129. 

College  of  Physicians  of  Phila- 
delphia, library  of,  328. 

College  Preparation  for  Study 
of  Medicine,  268. 

Colleges,  American,  270. 

Columbia  University  and  teach- 
ing of  sanitation,  250. 

Complete  Angler,  The,  304. 

Coney  Island  amusements,  141. 


Confidence   in    the   physician, 

322. 
Congress     of     physicians     in 

United  States,  317. 
Consumption,     cure    of,    232. 

value  of,  238. 
Continence,  Sexual,  112. 
Country  life  preferable  to  city, 

122. 
Country  practitioner,  305. 
Courts    defining    practice    of 

medicine,  237. 
Creasy's  Battles,  266. 
Culture,  neurotic,  129. 

Darwin,  Charles,  177. 

David,  45. 

Day,  The  Present,  342. 

Declaration   of  Independence, 
medical  signers  of,  319. 

Definition  of  practice  of  medi- 
cine, 290. 

Delusions,  Christian,  178. 

Department  of  the  Interior,  15. 

Diffusion   of  Medical    Knowl- 
edge, 259. 

Disease  and  ignorance,  264. 

Diseases,  salutary,  234. 
self-limitation  of,  174. 

Divorce  and  sexual  vice,  106. 

Doctors'  Sons,  335. 

Doctor's  work  in  the  future, 
230. 

Doctus  sed  non  Doctor,  282. 

Double    standard     of     sexual 
morals,  106. 

Dresden,  prostitutes  in,  109. 

Drug  nihiUty,  239. 


350 


INDEX 


Drugs,  action  of,  235. 
becoming  obsolete,  228. 

Eating  and  Talking,  199. 

Eclectic  medicine,  286. 

Edison,  Thomas,  177. 

Education  and  the  Health  and 
Efficiency  of  Girls,  128. 

Education  of  the  public,  261. 

Emerson,  R.  W.,  242. 

Emmanuel  movement  and 
Kindred  Phenomena, 
181. 

Epilepsy  and  alcohol,  63. 

Euripides,  62. 

Eustis,  William,  319. 

Evil,  The  Social,  124. 

Evolution  of  Scientific  Knowl- 
edge, 205. 

Examinations,  State  and  Col- 
lege Medical,  281. 

Exercise  and  Health,  46. 

Expert  medical  witness,  292. 

Facts  and  Theories,  194. 

Family  Hazard,  197. 

Fate  of  Medicine,  240. 

Federal  Interest  in  the  Health 
of  the  People;  7. 

Federal  supervision  of  milk 
production,  249. 

Fetichism  and  medicine,  222, 
228. 

Fitness,  Physical,  at  the  Throt- 
tle, 134. 

Freeman,  Nathaniel,  319. 

Fresh  Air,  150. 

and  tubercvdosis,  153. 


Future  Fields  of  ^ledical  Activ- 
ity, 245. 
Future  of  Medicine,  345. 

General  Practitioner  and  the 
Clinical  Assistant,  299. 

Generation,  Spontaneous,  216. 

Gibbon,  Edward,  267. 

Girls,  health  and  efficiency  of, 
128. 
teaching  of,  93. 

God,  The  Word  of,  97. 

Gonorrhea,  71. 

Gould,  George  M.,  160. 

Gray,  Asa,  214. 

Gymnasium,  German,  272. 

Haeckel,  Ernst,  217,  218,  219. 

Hair,  superfluous,  36. 

Hall,  Lyman,  319. 

Hand,  Edward,  319. 

Happiness,  Healthfulness  and, 
42. 

Harvard  and  Tuskegee,  274. 

Harvey,  Wilham,  196. 

Hazard,  The  Family,  197. 

Health,  efficiency  of  girls  and, 
128. 
more  important  than  prop- 
erty, 246. 
national  department  of,  14. 

Health,  Exercise  and,  46. 

Health  of  the  People,  Federal 
Interest  in,  7. 

Healthfulness  and  Happiness, 
42. 

Heating  devices,  157. 

Henry  VIH,  131. 


24 


351 


INDEX 


History,  Medieval,  338. 
Historj''  of  ]\Iedicine,  330. 
Homeopathy,  225,  286. 
Hospital  Interneship,  276. 
Human      Progress,      Medical 

Science  and,  251. 
Huxley,  Thomas  H.,  86. 
Hypothetical  question,  295. 

Idle  Wives,  Unmated  Men,  and 
the  Venereal  Peril,  118. 

Ignorance  and  disease,  264. 

Immunity,  Unhygienic,  147. 

India,  starvation  in,  5. 

Infant  feeding,  24. 

Innocent,  protection  of  the,  82. 

Instruction  of  the  Young  in 
Sexual  Hygiene,  86. 

Interneship,  The  Hospital,  276. 

Irvine,  William,  319. 

Japan  and  medical  council,  6. 
exaltation    of    medicine    in, 

252. 
Japanese,  absence  of  prudish- 

ness  in,  115. 
Jubilee  Membership,  340. 

Kassowitz,  Max,  220. 

Knowledge,  Evolution  of  Scien- 
tific, 205. 

Knowledge  versus  Manners, 
320. 

Labor,  joyful,  53. 
Lake  Champlain,  13. 
Lange,  F.  A.,  217. 
Law  defining  practice  of  medi- 
cine, 237. 
Lazere,  Jesse  W.,  206. 


Learning,  available,  279. 
Lecky,  W.  E.  H.,  110,  267. 
Libraries,  i\Iedical,  325. 
License  to  practice  medicine, 

286. 
Life,  A  Well-ordered,  309. 
Life  Insurance  Interests,  144. 
Lindsey,  Judge  B.  B.,  166. 
Linnseus,  214. 

Lives,  human,  destruction  of ,  15. 
Longevity  increasing,  17. 

Malaria,  238. 

Manners,  Knowledge  versus, 
320. 

Materia  medica  and  thera- 
peutics, 224. 

McDowell,  Ephraim,  207. 

Medical  Activity,  The  Future 
Fields  of,  245. 

Medical  education  to  meet  the 
new  conditions,  249. 

Medical  Expert  Witness,  292. 

Medical  Ivnowledge,  The  Diffu- 
sion of,  259. 

Medical  Libraries,  325. 

Medical  Library  and  Historical 
Journal,  331. 

Medical  Practice  in  Utopia,  341. 

Medical  Science  and  Human 
Progress,  251. 

Medical  society.  The  Small,  333. 

Medical  temperance  movement, 
69. 

Medicine,  History  of,  330. 

Medicine  not  a  business,  240. 

Medicine,  Practice  of.  Legally 
Defined,  290. 


352 


INDEX 


Medicine,  preparation  for  study     O'Dwyer,  Joseph,  207 


of,  268. 
Medicine,  Preventive,  255. 
Medicine,  The  Fate  of,  240. 
Medicine,  The  Future  of,  345. 
Medicine  the  sanitary  science, 

237. 
Medieval  History,  338. 
Membership,  Jubilee,  340. 
Mental  competition,  48. 
Mercer,  Hugh,  319. 
Milk  supply,  14. 
Mind,  influence  of  body  over, 

186. 
Mind,   influence   of,    over   the 

body,  185. 
Monogamous  household,  107. 
Morality  and  happiness,  44. 

sexual,  100. 
Morrow,  Prince  A.,  71. 
Mortality  in  the  United  States, 

10. 
Mother,  reverence  for,  95. 

the  best  teacher,  91. 
Motherhood  and  wifehood,  131. 
Municipal      departments      of 

health,  248. 

Napoleon    and    the    Empress, 

197. 
Natural  sciences,   teaching  of 

the,  87,  132. 
New  York  City  department  of 

health,  248. 
Norway  and  venereal  diseases, 

111. 
Nursing  of  infants  distasteful, 

37. 


Old  knowledge,  need  of  formu- 
lation of,  233. 
Osier,  William,  236. 
Osteopathy,  190,  225,  227. 
Out-door  sleeping,  162. 
Oxygen  in  pneumonia,  229. 

Pasteur,  Louis,  11,208,'211,219. 

Patent  medicines,  235. 

Peril,  The  Venereal,  70. 

Phallic  symbolism,  82. 

Pharmaceutical  fetichism,  228. 

Physical  Fitness  at  the  Throt- 
tle, 134. 

Physician's  CaUing,  The,  344. 

Physician  in  Politics,  The,  315. 

Pinard  on  syphilis,  77. 

Play,  Work  and,  305. 

Pliny,  214. 

Politics,  The  Physician  in,  315. 

Poor,  sanitation  among  the,  29. 

Practice,  Medical,  in  Utopia, 
341. 

Practice  of  Medicine  Legally 
Defined,  290. 

Practice  of  medicine,  state 
licensure  for,  286. 

Practitioner,  The  General,  and 
the  Clinical  Assistant, 
299. 

Preceptor,  The,  297. 

Preparation  for  study  of  medi- 
cine, 268. 

Preparatory  schools,  271. 

Present  Day,  The,  342. 

President,  Cabinet  of  the,  7. 

Press  and  sexual  vice,  107. 


353 


INDEX 


Prevention  of  disease,  26,  246. 

of  tuberculosis,  337. 
Preventive  Medicine,  255. 
Profession,  a  united,  259. 
Prostitute,  the,  100. 
Prostitution,  warning  against, 

110. 
Prudishness,  89. 
Ptomains  and  cucumbers,  235. 
Public     health     and     Marine 

Hospital  Service,  12. 
Public  life,  physicians  in,  318. 
Public  Pohcy  and  the  Medical 

Profession,  3. 
Pure  food  bill,  12. 

Quiz  compend,  283. 

Radiator,  the  hot  air,  157. 

Railroad  wrecks,  135. 

Rationalization  of  Therapeu- 
tics, 229. 

Ray,  John,  214. 

Reed,  Walter,  206. 

Religious  superstitions,  96. 

Reporting  of  venereal  diseases, 
108. 

Roosevelt,  President,  22. 

Rules  for  sexual  conduct,  82. 

Rush,  Benjamin,  319. 

Sabbatic  traditions,  307. 
Sanatarian    taking    place     of 

priest,  251. 
School  rooms,  ventilation  of,  28. 
"Schools"  of  medicine,  256. 
Scientific      ICnowledge,      The 

Evolution  of,  205. 
Sectarian  medicine,  256. 


Semmelweis,  Ignatz  P.,  196, 
266. 

Sexual  Continence,  112. 

Sexual  Hygiene,  Instruction  of 
the  Young  in,  86. 

Sexual  morality  and  the  State, 
100. 

Sexual  wrecks,  45. 

Shaw,  Chief  Justice,  293. 

Shaw,  Lauriston  E.,  284. 

Signers  of  Declaration  of  In- 
dependence, 319. 

Single  medical  examining 
board,  287. 

Sleeping  out  of  doors,  167. 

Social  Evil,  The,  124. 

Social  scale,  The,  37. 

Societies,  medical,  260,  339. 

Society,  The  Small  Medical, 
333. 

Solomon,  45. 

Sons,  Doctors',  335. 

Spencer,  Herbert,  7,  81,  129. 

Spontaneous  Generation,  216. 

State  and  College  Medical 
Examinations,  281. 

State  departments  of  health, 
248. 

State  License  to  Practice  Medi- 
cine, 286. 

State  and  Sexual  Morality,  The, 
100. 

Statistics,  xntal,  16. 

Sterihty,  74. 

StiU,  A.  T.,  192. 

Strode,  Muriel,  210. 

Study  of  medicine,  preparation 
for,  268. 


354 


INDEX 


Summer,  Accidents  of,  138. 
Superstitions,  pernicious,  95. 
Sweden,  venereal  diseases  in, 

111. 
Syphilis,  71. 

Taft,  President,  22. 
Talking,  Eating  and,  199. 
Teaching  of  girls,  93. 
Teaching  public  medical  sub- 
jects, 266. 
Temperance  movement,  55. 
Tenements,  model,  30. 
Theaters     and     sexual     \'ice, 

105. 
Theories  and  facts,  194. 
Therapeutics,  new,  231. 
Therapeutics,    Rationalization 

of,  229. 
Therapeutics,  The  Beginnings 

and  Progress  of,  221. 
Thornton,  Mathew,  319. 
Throttle,   Physical  Fitness  at 

the,  134. 
Tobacco  smoking,  42. 
Tonsils  and  adenoids,  163. 
Treves,  Sir  Frederick,  234. 
Trichinosis,  diagnosis  of,  279. 
Tropics  to  be  made  habitable, 

252. 
Truth,     The     Borderland     of, 

343. 
Tuberculosis  mortality,  9. 
Tuberculosis  preventable,  337. 
Tuskegee  Institute,  274. 
Tyndall,  John,  177. 
Typhoid,  economics  of,  18. 
in  the  United  States,  257. 


Unhygienic  Immunity,  147. 
University  and  coUege,  271. 
University  of  London,  history 

of  medicine  in,  331. 
Useful  recreation,  50. 
Utopia,    Medical    Practice    in, 

341. 

Vacation  and  vocation,  140. 
Venereal  disease  in  New  York 

City,  79. 
Venereal  peril,  idle  wives  and 

the,  118. 
Venereal  Peril,  The,  70. 
Violations  of  chastity,  83. 
Virchow,  RudoK,  217,  219. 
Vulvo-vaginitis  in  children,  76. 

Warren,  Joseph,  319. 

Well,  A  Plea  for  the,  23. 

Well-ordered  Life,  A,  309. 

Wifehood  and  motherhood,  131. 

Wild  oats  unnecessary',  94. 

Witness,  Medical  Expert,  292. 

Wives,  idle,  and  the  venereal 
peril,  118. 

Wolcott,  Oliver,  319. 

Woman's  Christian  Temper- 
ance L'nion,  57. 

Woods  Hole,  Marine  Biological 
Laboratory  at,  205. 

Woods,  Matthew,  63. 

Work  and  Play,  303. 

Work  for  wives,  120. 

Work,  manual,  in  college.  273. 


Young,  Instruction  of,  in  Sex- 
ual Hygiene,  86. 

355 

a) 


DATE  DUE 


JflN  (^ ''  \ 


1  2  2004 


RIES 


■  at  the 

~—  'owing, 

;ial  ar- 


" OEMCO  38-296 

